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TREASURY Department, 

Document No. 2:522. 

Offijce of U. S. Marine-Hospital Service. 



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8 CONTENTS. 

Report of fatal cases, with necropsies 93 

Contributed articles _ 221 

Observations of surgical clinics. By Surg. G. T. Vaughan 2S 

The United States Marine- Hospital Service. By P. A. Snrg. M. J. 

Rosenau... 230 

A case of appendicitis, with operation. By Acting Asst. Surg. Robert C. 

Craig - - 237 

A case of appendicitis , with operation . By Acting Asst. Surg. Robert C. 

Craig .- *- 238 

Appendiceal abscess— operation — recovery. By Acting Asst. Surg. Rol> 

ertC. Craig 23^ 

Statistics of the Marine-Hospital Service 241 

Tables showing patients receiving medical and surgical treatment dur- 
ing the year 243 

Division of sanitary reiK)rts and statistics 315 

Public health reports - 317 

UnitedStates 317 

Plague in San Francisco — table ... . , 318 

Tuberculosis _ 31^i 

Smallpox 31?< 

Table --. 319 

Foreign and insular - 337 

Cholera . 337 

Table . aST 

Yellow fever . . 33t< 

Table _._ 338 

Plague 339 

Table 840 

Smallpox _ 344 

Table 344 

Division of insular and foreign quarantine and immigration 349 

Cuba ..- . 351 

Report of chief quarantine officer, including report of transactions 

at Habana and subports, first quarantine district 351 

Reports of transactions at other ports — 

Matanzas and subports, second quarantine district 362 

Nue vitas and subports, third quarantine district 377 

Santiago and subports, fourth quarantine district 381 

Cienfuegos and subports, fifth quarantine district . H89 

PortoRico 394 

Appointment of chief quarantine officer and organization of the 

service 394 

Status of Miraflores Island, San Juan 395 

Reports of transsictions — 

San Juan and subports . 397 

Ponce ... - - - 400 

Mexico .... 401 

CTianges in assignment of officers at various ports 401 

Instructions to officer at Vera Cruz 403 

Reports of transactions — 

Vera Cruz 402 

Progresso - - 404 

Tampi(H). 405 

Central and Sf)uth America. Irnit port-inspection service. . . 4(H> 

Final reports, season of lU(M) — 

Ceiba - . 40(5 

Belize 100 

Bo<as del Toro. K)7 

Limon . 407 

Livingston . . 409 

Bluetields . . 409 

Puerto Cortez 409 

Season of 1901 , reestablishment of fruit j)ort insi)ection ..... 410 

Regulations for government of fruit vesstils 410 

Re])orts of transactions — 

Ceiba 411 

Belize 412 



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10 CONTENTS. 

Division of domestic gnarantine — Continued. Pajce. 

Transfer of Florida quarantines to the National Government 482 

Agreement between United States Treasury Department and State 

authorities of Florida 483 

Texas-Mexican border quarantine 485 

Reports of transactions — 

El Paso, Tex 486 

Eagle Pass, Tex 487 

Laredo, Tex 487 

Quarantine decisions regarding Chinese food products 487 

Dubonic plague at San Francisco, Cal , 491 

List of cases 491 

Correspondence and measures taken — 

October, 1900 492 

November , 1 900 494 

December, 1900 495 

Detail of Surg. J. H. White 500 

January, 1901 501 

Commission of expert diagnosticians appointed 505 

Suspicious pneumonia at Bakersfield 508 

February, 1901 510 

Correspondence with the governor of California 514 

March, 1901 522 

Report of commission of exi)ert diagnosticians 523 

Agreement for cooperation with representatives of Califor- 
nia and San Francisco 535 

Results of commission's investigation communicated to 

health officers and others 537 

Surveillance of Chinese in Pacific coast towns 543 

April, 1901 - - 546 

Disease at Bakersfield apparently acute lobar pneumonia. . 547 

May, 1901 554 

June 1 -October 31, 1901 559 

Report of Surg. J. H. White on work in Chinatown 562 

Smallpox in the United States 578 

Summary of prevalence and mortality, 1 895-1 901 578 

Assistance rendered State and local health authorities 679 

Smallpox in Alaska - 579 

Report of officer detailed to investigate 579 

Aid rendered by the Revenue-Cutter Service 588 

Yellow fever (none reported in the United States) 588 

Proposed plan for international agreement of American republics — 

sanitation of yellow-fever seaports 583 

Yellow-fever institute 582 

Hygienic laboratory 587 

Assistants in the laboratory — class work 589 

Yellow fever 590 

Insects as factors in the conveyance of disease 592 

Bubonic plague 598 

Disinfection experiments 594 

Danyz's virus and the destruction of rats . 594 

Pollution and purification of water supplies. - 596 

Portable laboratories of the Service . . , 596 

New lalKiratory building 597 

A])])endix No. 1— Search for the bacillus icteroides, by Asst. Surg. D. H. 

Cnirrie " 601 

Apiwiidix No. 2 — Filtration of water supplies — c()in])arison of slow sand 

and mechanical processes, by P. A. Surg. H. D. Geddings 610 



ANSTAI. RKI'ORT 

or TMB 



SITERUSING SrRi;B)N.GL\ai\L MARINE-BOSPfTAL SERVIfE 



REPORT TO THE SECRETARY. 



I^RKAHrKY llRrAimfKKT, 

i^rru'H tir thk sii-kkvihinu .snuiKos-tiKSEHAL 

MaKIN'R ll«»9il'ITAL SKRVU'E, 

Uim, I*. J. CffAfiR, 

•Srnrr l#i r y nf th^ Trrt im ury 

Hm: I bjiv<» tht* hiiii<»r 1<» Mtihniit I hi* fdllowiiiK rr»|Mirt of (mnnAr 
tifffijicif thf MAniH* ll«p»|iitjil S*rvi«*«*of iht* rnil«M| Stutf^fi for thi* fimik\ 
yr«r ••ntlftl Jiint* -)*•. I •*•!. iIm* nj%mv Immiiv; the lhiriif*lh Miinuiil n«|H>fi 
of thf* Si*r\'tm< Attil thf* ont* htiiiilrt««i miil thini %*Mir of iln rxintrnt***. 

WhiWi thf* nuijitr |»ortion of thi<« r^«|iort inf*liulf*fi only thiMi* tninpiii«*- 
tionn |irior Ui July I, ltM»l. iIm* ofll<*<«r in c^hnricf* tif tht* <itvi<iton of 
in«iiUir aihI fiitviipi f|UAmntint* urn I inimiirvntion han ff*mlioflit*<«l in hU 
report iiu|»|iW*iiit»ntiil rt* |iorlM fn>ni f*<i«rtiitn MutionA pihovin): th«* work 
to Sr|iCeiiilii*r 15. 11«)1, iin«l lioth in hi«i n*|Mirt j%n«l in (h«« rr|iort of th«* 
il«»ffif«iilir i|tiiirmiitiiii*ili\ i«»i«»n tht* o|ifnitionfi of th<* Si«r\ic^, in Krvi*nil 
iiii»tAiit^c<ii wh«*n* it wam «lt*«*nit<<l utH^^tmmry to t*«iiu|ilet<* tht* niimiiioti, 
nrr rf>fiortr«l u|i to tht* |ir«*«if nt «lj%lff* 

Full rr|Mirtfi of tht* Sfr\ ii't* o|M«nitii>nii. in flt^tail, by ofllcHini in rhurjjf 
of thf* tllfff*rf*nl «liviiii«inii of th^ lturr«u follow, but I will itiit* h«*r»* 
m rrrirw of thf work of tht* Sfr^ic^* ninrt* \o%'t*mb»r I, lln*», in brirf 

Th^ commiMloiiml mqw Mt th«* rliM* of the flur^jil yi^r r«mfttiit<^l of 
|4MFt oAfl^m, Inrluclinit the SurKr<iii tteneml, TJ nury^mm^ :f3 imimw^I 
AMiifttjint Mirvr<»tii», «ii«l X\ iiiMiutiint fiuri;r«»iiji. Noni^MuntiiiiUon«*«l «»tf1i 
rf*r»- 1^M% A<*ttiii; AMiiiitiint iiuri;i*«»u»« whirh inrluiltm iill oftlf^rH of tht<i 
irrRilr In 4 uim anil tlir Innuliir {MMM^wiloiiii. ami 4*' him|iltal RtewiiriU 
litflijbiiiii ami i|uarantHtr> Mttt«n«lanti«, «»|n tine ofllc^r, \gm%, ^ur)^ 
W. k. I'Maun, reiilgttrtl S)«?|it«*mber ::, VM»r 

Act'tii'KTH 

Tik* haUii«y« of th«« marini^hoaftital fuml a%'ailableat the e«vtnmenc^ 
HMfOt of the Am^I year wan f773,.113.4^ Thee%|iemlilun*« on a<^r<iunt 
ui file llarme iloa|ittal Ht^rvlr«* were f*«^l,Mi5 46 I'ht* amount a\ail 
Ablf* July 1. Itnil, wan IT;ftj,7A:f.7l. 'Hie ei|irtt4lilun*« frtiui thin fuml 

II 



12 MARINE-HOSPITAL SERVICE. 

have beeu larger than usual on account of the growth of the Service 
and the increased relief furnished, and because Congress purposely 
excluded marine hospitals from participation in the annual appropri- 
ations for repairs, furniture, fuel, light, and water, and from special 
appropriations for iraprovementSj these items being i)ayable from this 
fund. 

The balance of the appropriation ''Preventing the spread of epi- 
demic diseases," available Jul}- 1, 1000, was ^408,581.90; the appro- 
priation act of March 3, 11)01, $500,000; and repayments, $0,233.20, 
making a total available during the year of $974,S15.22. The expend- 
itures were *175,253.41, and the balance July 1, 1901, was *799,5G1.81. 

MARINE HOSPITALS AND RELIEF. 

Fifty-six thousand three hundred and eighty-one sick and disabled 
seamen of the merchant marine were treated during the fiscal year, 
being 2,020 in excess of the number treated in jjrevious years. There 
were 13,341 treated in hospital, the remainder being treated as dis- 
pensary patients. 

There were 1,309 important surgical operations performed requir- 
ing the use of anaesthetics. 

The Service owns and operates 21 marine hospitals, and operates 
two additional hospitals in leased buildings (New York, N. Y., and 
Dutch Harbor, Alaska). There are besides 115 relief stations w^here 
patients receive hospital or dispensary treatment. Three relief sta- 
tions of the second class have been established during the year at the 
ports of Honolulu, H. I., San Juan, P. R., and Ponce, P. R., and 
three others at the close of the last fiscal year. 

HOSPfTALS NEEDED AT NEW YORK AND BUFFALO. 

I have to lenew my recommendation that the hospital and grounds 
at Stapleton, N. Y., now rented for the care of patients of the Serv- 
ice, be purchased by the Government for this Service, and that Con- 
gress be requested to appropriate a sum sufficient for this puri)ose. 

A marine hospital is ahjo needed at the port of Buffalo, N. Y., and 
I have to recommend that Congress be requested also to make appro- 
priation for purchase of site and erection of a hospital building at 
that port. 

SANATORIUM FOR CONSUMPTIVES, FORT STANTON, N. MEX. 

The equipment of this station is now nearing completion, and the 
repair of the buildings and the improvement of the reservation have 
proceeded as rapidl}' as possible. 

Tuberculous patients admitt<Ml to hospital at other relief stations 
have lxH*n transferred as promptly as their condition wx)uld permit, 
with resulting benefit to the individual transferred and diminution 
of the risk of infecting other beneficiaries of the Service. The sta- 
tion has been supplied with modern sterilizing apparatus wMth a view 
to])reventing the infection of tlie sanatorium itself. 

There were in-patients admittcHllo the sanatorium during the year. 
Eighteen wen* discharged cured, 42 improved, ',) not improved, and 17 
died. 

1 UKVEYINO DEPOT, NFAV YORK. 

le mariin^ hospitals and quarantine stations in the United States, 
lii, Cn])a, l^orto Rico, and tlu* Philippines receive their supplies 



llAKI?CK*lli>!«l*lTAl. ^KKViriC. 13 

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lUtMitiA %if*n* niU«<l «liiritii; iIm* yvnr 

411* T*» "TtlKII <«ftil%t4f>. 

AmI wiM» t«\i«*tifli««| III «iilM*r limiKlifiiof Um* <t«*\t*rnitM*it* M*r\'i<^*<liir- 

Tm th«* l.iffNit\ in;: >«T\ n't-. Ill thr |>li>fii<'al <-\iiitiiitj%(ioit of l.4l.% 
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H\MT\|t\ HKI'i»I:Th \Mi sTATIsTIt •% 

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ruiit«>tiifs ht*jilth of!h«T^, ;tii«t oilivr •s;ini(nrtiin<». Iirt\i' now j% finMilnlion 
of :?.:!*i<» |{«*|iiirtH Win- rtM-^^x**! «liirtn^tli«* )f*iir fnmi 1.4 47 imIm** ««*«| 
t4»«n^of tht*l iit!««l *^Tat«-«». %i ith an iiw'U»*»'U«»*«* |»«»|»ulAtion «»f .''♦.•♦*.•*.•. 7 i**. 
jin«l fr»tm IP'of ihf |ir!iiri|ibil f«»n'i;;n niif^* 

In jMl«lition to |iiitili«%!i.ni: tli** inortitItt\ tati)t*^itn<l lithh^n of t*pi4t*niir 
«li««-ai»t*^ Aji n*iiort«*«l fn»iii fh** \iir;oti<« i:ti4*<i fin«l town** of lh«» worlil, 
njHirt)* arf* |Miiilt<»hf*«l frinii Ui»» otli«*«»t '»of th«* >«*r\ t«*«*«ti«l «*«in«%iiljir ofTi- 
i-^i* r«*liiti\ •* lo tho b«*4ilt)i «Hiii«|i: ton% **( I U • «iMinln«"» in w hh'li !hi»> ar** 
MAti<in«'«l Tin* Ptitilii* li«*^ttli l(«'|iortM for ()i«* mlt^ndnr >i*i%r « nilt*«l 
l>t'«'^mli»'r II, !••»■», ninl4iin«*«l l.lvl |ni^«»<%. Mn«l ^vn* lunimi in two 
%"oIijnif** 

IN-^ILAIC \M» ri>KKI«*N vr.%KA\TINK. 

niirini; tht« yi^jir th<* Miirtn** llo^piiiii >«*r\ n*** hi%^ n»n«liirti«i| miin- 
titiit* i|iijinin(Ui«* in t ulm, Porto l(if*«i. ll^iwttit. i%n«i tlit* l*liilippin«*^ 

Fltmlini; ilimnfr^'tin;; pUnit i«rv nom f»tiiti«in«Hl nt Il«\iin4i, Miitan 
«JM», SjintiA^*, iin<l rtf-nfitt*^<M. j«h«i n pUnt m ntim in f*«>iin«r of cnmi 
•trtii*iion Mt tli«* |ii»r1 of i|ji\«inii for u<m* At \ii«*\itiii» .\ (1o«tinie piAiii 
Haa \mH*u MtAtuintxl Ml >An Jnnn. 1* IC . Mn<l Anoth«*r plmit m now 
c^»fti|il«<tc^l for UM* At tilt* fiort of l*ott<^\ 1* IC 

lMAinf«*«*ttn(; niAt*liint-r\ lut% l»i*«*ii in<»iMUf«l on tlit* <'liAnn«*l wliArf itt 
llofMilulii. Hawaii. Anil r>%tt*ii<»i\i* r«*|Nttr^ Ar«* iiiHl«*r «a> At flit* ifiinr 
Antiit«« ftiAtton At MAiilioU |<»lAn«l. in llit^ liArliorof Honolulu ln«»|irt*> 
Ii4»n »tAtii*nii Ari* aIim> i»|MrAt« il At Hum. KAliultit, An«l Kili«*t ICoimlrA 
Att«l inipro\fnM*nt ^ Iia^** l«t*«'ii iiiA«l«* At M^irixflt-^ i^tiArAiitin** SlAtion, 
tiTAr VlAntlA. 1' I . inrlii«loi|; tlo* i*«>n«>tru«*iion of a wlmrf, with «li«»in 
1rr%^t%fg niA«*liin«*r\ iii^tAh«'«l ili«-f**t>n. r«*iHl<'rini; thin i»nr of th«* lM*%t 
rtiUlplw-^l *|iiArAntint* i»lAtt«*ii% iiii«|tr iht* f«*ntn»l of lh«* >«*r\t(^* 

MrtlirAl ofYii^^r*! hA\«* Im<«*ii on «|iit <^ At tht* |ti»rt« o( |jon«lon. I.i\t*r- 
|AAil, Ati«l \Apl«^« in t'liirtiftis Aliwi At 4^tM'lM*«\ t AnAtht, f«ir tni»|ir««*tion 
cif AlirttA mttiaint* tii thr I nitt*«l MAt«<«i 

TIh* ln»|KH*fion of thi* Ar>\i*n frtiti |iiirt» of CVntml Atnl Nttuth 



14 MARINE-HOSPITAL SERVICE. 

America, namely, Belize, liritish Honduras; Livingston, Guatemala; 
PuertrO Cort^z, Honduras; LaCeiba, Honduras; Bluefields, Nican^ua; 
Port Limon, Costa Rica, and Bocas d(»l Toro, ColombiH, has been 
reestablished for the purpose of inspecting all vessels bound from 
said i)orts to ports in the United States, with a view to facilitating the 
transportation of fruit witliout endangering the public health. 

Following is a list showing the number of officers at national quar- 
antine stations in our insular possessions: 



CominiH- 
tdoned. 



Hawaii 3 

Porto Rico 2 

Phili])i)inos 4 

Cuba ! 5 



Acting 
awistaiit 
sTUfreons. 



fltewmrdik 



3 


I 


8 


1 


1 


1 


29 


2 



Officers liave also been on <luty at the i)orts of Vera Cruz, Progreso, 
and Tampico, Mexico; Kio Janeiro, Brazil; Hongkong, China; Yoko- 
hama and Kobe, Japan, for the inspection and certification of vessels 
and passengers leaving for the United States. 

DOMESTIC C^UARANTINE. 

There were during the year 4,720 vessels inspected and 366 vessels 
disinfected at national quarantine stations. At the close of the fiscal 
year the Marine-Hospital Service owned 13 complete maritime quar- 
antine stations and controlled 21 stations where inspection of incoming 
vessels is conducted by officers of the Service. 

FLORIDA QUARANTINE TRANSFERRED TO THE GOVERNMENT. 

August 1, 1901, the State authorities of Florida transferred their 
quarantine stations and functions to the Marine-Hospital Service. 
They were accepted under the provision of section 8 of the act of Con- 
gress ai)pr()ved February 15, 1893, in like manner as the quarantine 
at Savannah, (hi., was accepted in 1900. 

One station. Mullet Key, wa.s purchased under act of Congress June 
6, 19CX). The other stations were leased for a period of three years. 
Of the stations thus acquired, are equipped for disinfection, and 
are lo(»at;ed at Fernandina, Miami, Key West, Mullet Key, Carabelle, 
and Pensacola. The other stations, 5 in all, are for inspection only. 
The Dej)artment has agreed to recommend to Congregs legislation 
necessary for the purchase of the stations, and estimates have accord- 
ingly been included in the Book of Estimates for 1903. 

In the preliminary measures looking to the ultimate transfer of the 
Florida (luarantines to the National (Government credit is due to 
Surg. A. 11. (Tl(Minan, who acted as the representative* of the Bureau 
and of the Department, both in bringing about an enlentf cordkde 
with the Florida State health authorities and at Tallahassee in making 
known tin* r(»([uirements of the Department with regard to the neces- 
sary legislation to be enacted ]>v tlu? legislature of Florida. 

TEXAS-MEXICAN BORDER gUARANTINK. 

On account of th(» continued prevalence of yellow fever and small- 
Dox in the R(*public of Mexico, the land quarantine at El Paso, Eagle 



MAEIHK-UaoflTAL HKMVirK. l^ 

|*AiM». .iimI |jin<«lii. 'fV\ , liAVf lii«««ti iiiitiiitjiiiifHl jM» Iff! |>n'Vi<MiA >f«ni, 
Aii«l th«* oHm'^it^ i%tj%vi<iiitNl tlif*n« hiiv«* i*\«*rf*i«««<«l «ti|H*r\ i«i<iii tAiT thr 
f*iitr> ttii«i 'fV\i%ii of nil |H*nM»ii% fnMii M«*\i«*«t, jiimI Uhw ff*«Mi|H*riit«<«l in 
fht« ««>rL «ith till* riiit«««l Mjili-«» litiniiKmlifiit Si«r\ i<*r «ii«l with llif» 
SUit«* hrnltli j%iilti<iri(ifA Thfn* «fn« I.PU tmiiiii iii«|M^*t«<«l. mm- 
inir rrjCl |wiAM*iiiri*n», l*^* of mliom «rr«* «lftiiiiM<«l f<»r ulBM*r%'«tiiiii. 



«II41J.M»& 

Ihtntii; tlir \t%ir «tiiiill|Mi\ tiiii» Im^u r«*|iori«<«l in t*\f*r% Sfnt«* *tii<l 
'I'trrif(*r\ of lli«* t'iii*»ii. mlli llit* f*\<*«*|iliiiii of .\ri/i»iiii, fr«iiii «lii«*li iio 

I Im- iiiiiii)M*r of i-A^-^ rf|iorti-4| for Iht* «i\ iiioiitti% t*!!!!!**! |^^*<*iiilH«r 
:;i. 1 ••••. I*.-!* 7.7'W,. «ttli ! I' t|«'atli<i. A fiiorlAlit> of I T'l |N-r ••••lit. 

fiiMi '•*•.• <i«*alh«i. .1 tiionAl;l\ tif 1 7*» !•• r •vii! 

iii*>rtAl:t\ 1 7 7 |ifr i-^^iit. a«» omiiinn-^l i^illi |. '•.«•.'» ; «'a<m<% aimI 7.Vi <lfAthi» 
<|iiriii;: iKf \«'Ar fii4l«*«l Juih* •»'. I'"«'. a iiMir!Alil\ *•( I •* |»T «-«'iil 

rtiu<* tt i«% tM-**!! lliAt wliiU* iiM*r«' than I wh*«* a*^ itianv <'a*m*% hA%t* tii<«*n 
n't***M«-«t iliuih;; th«* \**Ar jiiAt frit|t<<l. th<* iiHirtaliU hA<» lM««>n lt*^«* ihAii 
\u%\i what It WA% 111 ill*- itn****-*!!!!;; >«*Ar Ttit^ t« |in»iiAM> to In* 
f\|ilaiti««| li\ th«' fA4'1 th.lt ftum-n m^ wrll Ah ih'Athn lii*n* nion« fully 
ri*|iiiri«'«l •liiriii}' th«* \iAr jii*t ••mh-^l, nhih* iti th«» im******!!!!!; \«'Ar, 
jilth>iti;;h iiM**t fif t*if i|«-jiih«t fmtii HitiAltlMtx •••!>• n*|iort«t|. th«-n' ip» tio 

• Utiih? rh.it .1 u''*J*' 111.111% •.!•-'•• of th«* «!i«*'A»*\ ft»r %Arioii% r«*A*Miii%, 
%»«f* !i..» rtj-.rT«*<| .\€i'«»ri!.iii; !•• Mii% f\|>*iiti.il ton thf loittT |i|»im*^, 
1 . .'. .Iff n» .irt-r tin «tirr«-« t iiHtrT.il.t \ . iiiitl ••\«ii thi» iiia\ !»• a litllt* 
••\. «•««.%«• .«% «l*'4th^ iir*' Mi«»r»- «i|it l«» !»•• n |»irt»*«l tliAti «'A«^'^ 

\% -.ti pft \ '•tu* \*i%r^ th«- M.tr.ii*' Ili«*»|i.tal ^tx i«t« hA«« n«ii«l«»n«<| 
jf««i«*.itM • f'* *^t.if«- .111*1 l4«.it UmnU of ht-Alth hy fiirtii<»hiiitf a«1\i<^ 
.iti'l •!• *.i ; t.«* ••^)>'«-r^ t<f iii.tk* ifi\ •-*»*. i^«|t ifiii% Aii«l A^^iM th«' >lAt4* 
j|irlH*r ! .• % :ri )»ii**iii^* ;ii*«> • iiiiitHtti |>ri')«r r«*;:tit;itii*it« I ht> (IHaiI 

• *f ••!?.•-• r% r:-.fS I.i«l \«-Ar tt> t ii|ii* Nfiint- aiMl lMit«*h ILirltor. iiiitlfr 
.iii!l)«irit\ «*f Aft K%t«iMi(i\t> ttnl*-r. «A^ n*iit*m«*«l thi«» %«'Ar, An<l in lh«* 
•prtij ot 1 •'! jiti f(Tut'r iii.i% «m*iiI to niALr a «-Ar«*ftil iii\«Mi^iiIm*ii of 
«Mi.i {li^x «tiii«li;iiiii% 111 ««MiilM*.ti»t«*rn AIai^Wa IIia n*]M»rf ^iMiwi^l a 
« -I* «|ir« .itl •h%<M'iii.ri.%! t*u »*t *m.ill|Mi\ in that n*s;i«»n 

|ti \ :« H «»f *Im* ti!Hi«kti.i! |tr«*\ aU'Iio* of ^riiAll|>»»\ thrt»iii;hoiit th<* 
1 Hi***.! Ht.|t« «» .,||«| ti» ii.tl tti A WA> thf i»ii|i|m-<«Ai<»li of It. twt» |iaHi 
l*hl«f% r* l.ttiii;* t<i th«* «hA;:n«i«i«. |ir«'\«*iitMHi. An«l «»ii|i|in*%^^M»n of iht* 
.1:^.»%«- Mli.<h»**r>* |irf*|Mn*4l l»\ iini«t*r« «»f lh«* >«*r\ i«^*, wfn* inAtlt^l 
t<i tiif III .lit h •'ftit «'r% (tr miImt iiitfrv^t*-*! |nT««»n« in tow ti% wlo-rt* %iiia1I 
l».\ n .%n r< |wir^««l t** Im< |»r««M>nt In llii% niAnn«-r lhf-^« |Miii|ihlfi% witi* 
«M iiY s* .' 1 •• i«iwii<» .tii«| intt»t*\fr\ >tAi«* iinil '|Vrritair> of th«« I tiittNl 

>t«|'i •. • \» f|»t «ttM 

1 li* f % .i»tt nt*«* ••! *iiiliiint«- |»lAi;nt' :u *^aii I rtiiii-i%i^*. %ilii«*h y^an Ur%% 
tiftit .%:'\ rt|«trit«l I'ti MAf« li 7. !'«•*. Aii<l «*f «klii<-|i nM-iititiii wam niA«l«* 
111 111% l.i%t tf|«iri. iiA% <*«inrlii(ii\rU ff^^^nfirnittl lt\ a • ttntintwkitii} 
.»l»tB*ititf«l lo il.t« I K-|Mrttii«-iii. f*«»fli*i%t ini; of tlir«*«* liAtf*t4«rtoliii;t%tM of 
til* liip,'tM «t n-|i itAtitiii. Aii«l With no |ir^-\ i*Mi« •-viniitftioti with 4ff«»\t-rn 
ii»« tit »«<r\ i«t\ w III* rv.t« ht^l Hin rrAn«*iM*«i in tin* IaIIt t*>»rt «*f JAniiAr\ 
1 * : rtii*l, Mft«*r An i*\hAiiMi%t* iii%r«li|;Aii«>n, n*n«lt*fv«l a fr|Hirt fMif^nf 
€lu<i.\«- in lU nAturr a» to it-^uU in ui«'AAurr« iMMn^; tAk^n t«> t-lranM* 



16 MARINE-HOSPITAL SERVICE. 

Chinatown, whoro the plague existed. In accordance with an agree- 
ment between the Department and the authorities of the St*tte of Cali- 
fornia and city of San Francisco, the work of inspection, isolation, 
and disinfectiim in Chinatown, San Francisco, was carried on by a 
corps of physicians and emph)yee8 of the State and city under the 
advice and direction of a surgeon and a corps of assistants of the 
Marine-Hospital Service. This work was comx^leted on June :31, at 
which time 1,180 houses containing 14,117rooms, luid been disinfected 
at a cost of about J^75,0O0, the burden of cxikmisc falling upon the 
local and State authoi-ities, the Treasury Department pjiying onl^- the 
salaries and incidental expenses of its own officers. Since the com- 
pletion of the work, an organization has been nuiintained for the pur- 
pose of making examinations of the sick and dead in Chinatown, and 
assisting, when requested, in the disinfection of premises where eases 
are found. Fift}' cases have been reported from March 0, 11)00, to the 
present time, 3i' of which occurred since October 14, 1900. 

The difficulties connected with the work in Chinatown are set forth 
in the detailed account of transactions published in the rei>ort from 
the division of domestic quarantine. 

YELLOW FEVER. 

Tliere has been no yellow fever in the United States since my last 
ref)ort, and, with the exception of a few cases that were reported in 
Natchez in November of last j'ear, there has been no yellow fever in 
the United States since the fall of 181)9. Reports have been received 
of the existence of yellow fever in Brazil, CoUmibia, Costa Rica, Cuba, 
France (on steamship at Havre), Haiti, Jamaica, Mexico, Salvador, 
San Domingo, and west Africa. Brazil, C/uba, and Mexico furnished 
a very large majority of the cases. In Cuba, from July 1 to Decem- 
l^r 31, 1000, there were 1,279 cases, with 298 deaths, a mortality of 
23.3 per cent; from January 1 to June 30, 1901, 114 cases, with 30 
deaths, a mortality of 34.2 per cent. 

The proposition to bring about an international agreement of the 
American Republics for the sanitation of certain seacoast cities, with 
a view to the elimination of yellow fever therefrom, which was referred 
to in my last two reports, has been generally so favorably received 
that, by invitation, a plan to effect such an agreement was submitted 
by myself to the chairman of the United States delegation for presen- 
tation to the conference of American States now in session in the City 
of Mexico. 

YELLOW-FEVER INSTITUTE. 

Recognizing the importance of arriving at full and definite conclu- 
sions in regard to all (luestions concerning yellow fever, its (^tiology, 
(*pidemi{* histoi-y, method of spread, and the influence that this will 
have on (luarantineand (quarantine regulations, there has been estal>- 
lislied within the Service (with Department approval) a y<^llow-fever 
institute, the object of which organization will be *' to collect all facts 
<*oncerning yellow fever; to designate the specific lines of investiga- 
tion to be made, and to make them."' 

The membership of the institute will consist of officers of the 
Mai'ine-IIospital Service, and otliers specially ([ualified, who will 
become members by invitation. A full account of this institute is 
".ontained in the report of the division of donu^stic (quarantine. 



llAKi:«K-lltlhriTAt HICKVU K. 17 

On l>«*«^*ttilipr I A, |v.n». thriN* ofn<*«*ni ut tlif ,Sfr%iiH« w«»n» clt^iKniitioil 
Aft A t^itnmifMioii t«i nut iniii f%fs«uti«in tht* |»n»%'iAitinii of tin* iM*t of 
r«iiiirn*fw. iiti|inivi«(l Vliin«h i, |h!i«i, |in>%'l«llti|( for iin invrMtiimtiott of 
|««|inHiy ill tht* rtiit«<«l Statin. Thiii fl^iniminMifm him n««rly I'ttitiiilftrtl 
it» UUirii, hii%iiii; nuMlr ««\hjiiiMi%*fl« iiiqiiiry in <*%f ry Stutt*. r«Minty, 
rity. town, mill hmnM iii the riiiti«il Stiit««, Ami will rrmlrr itJ» rvfMirt 
fur AulNniMiioii t«i t*onirr«*«A ••ii I>t«r«*nitii*r 1 nrxt. 

in i*IKM« I.AIt<>RAri>K\ 

Otii* hiitMlriHl th<iiioMiii4l <1«VM*<» «>f thf* \A<*<*itit* for liutHiiiii* |iUi;iif* 
hii\«* fii-«'ii |in*|Min<«l III till* hyi;ii*iiii* UlHimliiry Thin \jii*«'iiif. kiMnnii 
«,% li.i(TkitM* |»nii»h\ ln«*ti«\ i% nn ••ftliMfiit |in*\i*nli\«* iM;iiiti««t thiM cIih- 
«•«!«••. It ykH.% «M«iit to till* rhili|i|iinf NUncU, ti» llmmiii. iiti«l to nil 
our \m*nfk Oh till* pA4*ift«' c<iiiiiit llorM-^ wt-ri* tn*iit«*«| in onItT to 
4ililAin n «Mirfiti\f n«*nini f«tr y««llo« ff\fr, |iIih;ii«*. ty|ilMii<l ff\fr, mm\ 
|in«*iinioniii 

Stu<lif*f» iii«*n* iniMl<* with th«* Iwu'iUiif* muMiii^ hnUinir pluifut* in 
onl**r to «lt*ifrniiii«* iIh \iiiliiht\ iiii<l4*r mU |Mptf»ilih* <*«iiHlitionn. Th«« 
rr-nulln of ihtfM* «*\|M*riiii«*iit<». whirh Ji|i|it*nn<«l in i% lAlMinttor\ InilMin 
(No. I) «*ntillt*«i "'Hm* \tAtMlit\ of ih«* lMM*illn% |M*«tiv** hm* m <lirr«*t 
pmrtirAl tH*iirifit; ii|M»ti «|iiAmiitinf |inM*tii*«* 

K\|i**niiifnt% «t*r»* ji1<««i niH«l«* with iIm* milphnr «li«i\i«lf nml forni«l- 
«l*«h\<l«* iTHA. Ill tir«|«T t I •!« t«-rtiiifi«' tht*tr \ji)ii«* tin •li<»inft*4*tini; A|r>*litn. 
I.j|lM>nit«»r\ titill«-t iii«» %»«•-«• ^••ii**! ..fi ttiith «*f tht**M* %iilijn*t^ 

Ntm t ftfr*ii%r<»ii\ ht 11 i*i%tt. 

Th«* Ij»M C*oii;;r«-^*« .ii»|»Ti>:in.ii«-«l tli«* %tiiii fif f.l.'i,««»» for ii nt*w iMlmm- 
|fl*ry f«ir **th«* iii\*'«*ti;:4iiM'ii *»( iiif«*«*ti«*ii«% .iimI <*«intH;;ioti% «lifM*iiw<» iinti 
ttiatt«*r^ |H*riaiiiitik' ^<* th«* |iiit»ti<' h«*.illh " TIm* |»n*hiniiiitr> |iinn<» for 
tht* t««fn»tni4*ti**ii of thf liiiildiiit; i%n* iiom t**in;; «lrn«iii I h<* l.i)Mir.i 
ti»r\ ItJiM l<»ni: oiii(;r«iHii ii<» |»rv-^*iit <|U4irt«*r>». i%n<l tht* iif*ii liiiihlini; 
«ill |ir>-^*nt th«* |MM«iliiliti«% of nior«« work iin«l i%n fiili%ri^<«l m^viim*. thi* 
nrral «»f «hi<*h \u%% ♦•••••ii f«'It 

li:<.l*«l.\Th»\ \KKi»i:i* 

I lat^ tf*A%«* t«» iii\ it«* MiifiitMMi l«i tht* jii-t of ( <»ni;n*<«» hfrvtofon* 
f|U*»tr«i. M|t|ir«>v«*«l ^litn-h ». r«M. niiikini; ;i|i|*n»}irii«tion f«»r m nt*w 
liili*»tAttir% liiiililiii;; mikI «h*«'tj%rtii;; it t«i Im- *ft»-th<* iii\«-^ti(;Mtii»n of 
infrN-tioii« i%ii«l « tfiii«i;;i*>iio •li^'i^M*^ iiiiil iii.itt«*r« {M'liiiiii ii^; t«* tlio |»iil» 
In* lit<Altli IIh- !<'riii«% «»f thi<% *M-t, t«»|^*th«*i wth th** «*iif«»r«*«<iii«<iit of 

thf nAli«»n«l «|iiiiritiilitM- Li«i», aimI oiht-r <liilit*% iiii|wm»i-«I ii|ii»n ttif* 
Miirtnv* ll«M|»itMl >«-r\ K-v* r«*tAiiiii; l«* th«* |itili|ii* hf*Allh. iimki* ii-t-v-^ 
Mir> . Ill tii% •■|iiiii**ti %«iiii« t«*i:inljiii«»ii li\ t*«Mii;rt*^p» l>aikiiic t^i thr 
in« r«*jMM^I ff*fh«'i«'ti«'« ••( th«< Miritif il«Mi|iit«il >«*r% i«*f* i%% <% iMil»lif' h«*i«lth 
M*r% i<^* It !•» 111% i(if«*iitMiii. at •III «*4irl) «lAtt*. !•! |ir^*|inrr n mfimiirt* 
«#f thi* «'hjirji«-l«>r t*»t yur iiti|ir«»\ .il ««n«l »iiliiiiliM»i«»n t4» I 4ini;r**«i^ 
I h«%r th«* honor tt» rt^nmin, n^|w«*lftill> , 

U Al.Tr.ll WVMAV. 

.S'«ir«/rtif«- l#f ro f «i/ .l/'iriro •//«»«|»i/<iy .Si^ri iff 



IMVISMJN OF rKHSONNKL A\h At'lXM NTS. 



I» 



iBPoiT or TBI Dnrmov or maonnL um Aooonm. 

Uj iimmttm I*ih%'iaiic*c. 

.VtirywMi. t' S. M*irtmr*Htimptini Srrrttv, in (%arg^. 



l-^HmiMNlONKti MKMl'Al. CUiiil^ or THK HRKVirR. 

At Ui4» ljf*frinnirtir «»f thr fl<M*iil Vfiir. July 1. I'MMI, thriv wen* 107 
nHBinlMiloiird oArtTH in tlit* Mi«r% it^. iin«l no lulilitioiuil uAci^ni wrrv 
mMMiniiMilfMiril tliirinic th«* >f4ir. 

Tlir c*or|iN liipit 1 olllr«*r. AtmH Suric ^V. li. Kilaiin. who n*«ii|ni<*<l 

Two AwiUliint 9iurie«tMi« wt* rr |ininioU^I t4i thf* irriMlt* of iiammil mmlnt- 
Atit fiur|t>^>n. 

TW r«*rf]M c^innliiUi Hi (li<* vUtm* of iIh* ftm^ml ytmr c»f hNli i^mimiii- 
Monnl iilRrrns f^ ff»lti»«ii: 

n 

■t»4«iit •iinr*^*t»« t-i 



TuIaI tOi 

H4IAKIM roXVKS'RIl. 

Tw«i iMianln hjtvr Im^m f^mvrtit^l for thi* f mminiilion of oAc^m for 
l>r«HiiciCH>n from tlit* irnMl<«of AMiuMiint AurytMin t«i imimm^iI AMilsiijint iiur- 
frr«Hi« AAil All of!li^*ni onU^riNl Ui t^^jiniiiiiitkin for prttiacHkHi havii 
l«iMinl iiurv^t*f«*fiil f \j%ntiniili<inii. 

Twf» iMmnU mvr^ <^invrnr«l to miikt* tibymicAl t*ijiniiiiAlk>n of ii|i|iH- 
cmntii fi>r j%|i|iouiim«*nt t4i iHmitiftn of f*«ilrtAhi|> in th«* K<*%'««nuf^l*uttrr 
Smirt* (iHMinU wuTt* c^>nvfnt««l Mmy ^* untl Junt* 7. 1*.«»1) 

Onf> liofinl mmm t^in\t*nr<il to imikf |ihimir«l i*tiiiiiiiiAli4»n of SinhmhI 
Ajiiirtant Knicint^r l{ K lliiltiin. KrvrnunC*titt4«r S»*r«lrr. FfliniAi^' 

.^. l!li»l 

ilnr tMninl m$km «*«»fli%f*n<«il to inmnNlrr |iliinii ivliitivc* to r«Uililbili- 
mt*ni of A «|itjinintint* niAtion Mt Mullt*t Kf\, Kl^jri^lji. N«i%finlwr 

ir. r.-^* 

Ibnint r<iinvt*nr«l in NVw York (|iur>««%in|t •lt*|Hit ) fitr iwUicm 4»f 
Miti|>|y t4it4r, t>rt«»lifr :fl. !*««» 

.HyrRmm Aiiwlln wim <lfiiiilr«l m^ rluiirtnAn nf m t«iiinl Ub Ih* non%'f«niNl 
III l*lillAilr||»liiii, I'll . fniin titiit* Iti tiitir, fur llir |iiir|iMiM* uf rv««ijiin- 
mini? iiu<*h r««j«M*t«««l tmniii;r»ntM «» MhiHiM ii|t|H*«l to it, Miirt*lt :fH, pjol 

!t(o!«ci»iilltMHioMtl> MrrttRlCA, 

Tlifl^rp Wf*n» on tlut% iit thr IwifinninK of the* fUml y^mr 119 artinir 
AMkiMiiiiil Mianir«in« mm\ 41 t«*nt|Mir»r) Afrtinif a—irtant »urg«<«fiiik. niAkinR 

ft 



22 MARINE-HOSPITAL SERVICE. 

a total of 162. During the year 4 acting assistant surgeons have died, 
6 resigned, and 14 have been appointed. One hundred and thirty- 
seven temporary acting assistant surgeons have been appointed and 
115 separated from the service by limitation of appointment and 
resignation. 

The total number in the service at the close of the fiscal year is 188. 

All temporary acting aissistant surgeons on foreign and domestic 
quarantine and epidemic duty are included in the above statement, 

HOSPITAL STEWARDS. 

The total number of hospital stewards at the l)eginning of the fiscal 
year was 44, divided as follows: 

Hospital steward and chemiBt 2 

Hospital steward and assistant chemist . - 1 

Hospital steward, chemist, and special disbursing agent 1 

Senior hospital stewards 23 

Junior hospital stewards - 17 

One senior hospital steward died, 1 senior liospital steward was 
promoted to the grade of hospital steward and chemist, 1 junior hos- 
pital steward resigned and 1 was promoted to be hospital steward 
and disbursing agent, and 4 junior hospital stewards were promoted 
to the grade of senior hospitiil steward. 

Five eligibles were certified by the Civil Service Commission and 
appointed junior hospital stewards, and 1 senior hospital steward 
was reinstated upon certification of the Civil Service Commission. 

The total number of hospital stewards of the three grades at the 
close of the year is 49. 

HOSPITAL AND QUARANTINE ATTENDANTS. 

There were at the beginning of the fiscal year 547 attendants; 1,038 
have been appointed and 070 have been separated from the service 
by reason of resignation, death, desertion, and removal for cause. 
The following tables exhibit the transactions of the division as regards 
these employees: 



' T_™_^i !ApTK>intod Separated 

Branch of service in which employed. t«i^i iimmi ourinK from 

iJuiyl.IWM). y^j. service. 

Marine-Hospital Service :fil7 r>44 4»7 

guarantee irK) 'Mt !«) 

pidemic i :U | 289 284 

Total 578 \,{m JJTO 



In service 

Juneau, 

1901. 



444 

lOB 
96 



GM 



The number in the servi(»e at the close of the year is 040, exclusive 
of those employed in island possessions and Cuba, which are accounted 
for as follows: 



Tn HArvico ApiKJinted Separated I In Bervioe 
Tnlvl lilJ «urinK from June 30, 

juiyi.iwjii J. Hervice. 1901. 



Hawaii 

Porto Rico 

Philippine Islands 
Cuba 



8 

12 

129 



96 
20 
73 

177 



23 

10 

47 

199 



15 

18 

88 

107 



llAlCIX>:-ll«tt«riTAl. HKMVlf K. S8 

HfKrtil. I>KT4II> AMI Al*l*«»INTIir.MH <»|' « ti|||||HM|o\KI» AM> !^'o.\*. 
I «»|||||««ii|«iN|CI> «im< KRh, r||K<»N4»MM.h il.|.> iKKAX««Kt>. 

Suit* t«*tii|ii»niry it<*tiii^ ii*M%iMAiit f»iirvt<«»iiM %ii*n* Ji|i|it»iiit«*«l July 1. 
r"«», fur *|jty At \iih«»ii«« |M»fifi in Mi<iAiMpki|»|ii. U*r tlit* puqMifii* of 
c»l>tiiiiiiiii; 4littl\ iiifiiruiiitioii jt% ta tli«* lM*iiltliof tlM*ir n*»|itH*tiv«« l«Miili. 
tit*^. Aii«l f«>r iIm* furl lift |iiar|MM«* of |»ri«*tiriiii; iinitM««ltiit«* rt*|iiirii« of 
uii> Ati«|MM*t«*«l cM^i^ of y«*llo%i fff«\«*r. Thrir MrrvM^i*» w«*n* iliii|ii*n«inl 
%iilli ^N•|•t••ln^l••r M'. I"«» 

Ntir;; A II <*It*titiati %»it<» «l«*tiiilr«l i'liM*f 4|tiiinintiii«* uflli^T of tht* 
ii»liiii*l of i iilm. rt*lit\ iii^ Mtnr II H i i«ri«T July •». !!«■» 

V \ >ur;; A l( 'riiotnii.««. on i|iii\ m tlit* oftU^* of tin* rnili**! St«t«w 
fN»n«ul III Ivtuidon. Kni;ljin«l.w;i«.oti Aut^uM ;.*^, !'•••», on !••?>♦< I to |inM*««««<l 
to i«tji%j^'«»M . ><i>lhin«l. to tiiitki* oiN^t'inl ni\i^tt|;HtM»hH t>:i pl.i^u«* On 
J*iiiUi«r\ I '•, r«»l, hf 1ft H«» onli*n««l !#• >liifhU, Knidnn*!. for th«« H:iinr 
|Hir)Mi^* 

^nru l> A < HruiM'lijM*! wii<» «|ftiiil«*4| jt«» «*hit«f <|Uiimntin«* ofl|<H*r of 
tlo* 'l«-rritor% of lliiHitii Au^ruM ^11. I*««» 

A««#»t *^%tT}i i II l^i\ iii«lfr miiA «l«*liiil«*«| !!•» <*liit*f <|Uiininlin«* (iHli't^r 
of iIm* i«ilaii<l ««( l**.rt«i l()«Ni Au;:u<«t ill. 1'mri, ahiI «*onluiu<*il to nt-t im 
«iu«*h until ri'lif\«'^l li\ A*»»i •^ur^' II ^ .\|iitli«*WfMin. mh«> %in«, un«lfr 
•inlfT* of «K*t«>lH*r •». r»««». «lt'tnil«*4l «•• rhiff i|UJiriintin«* «»fTI«t*r of «gii«l 
i<il.tn«l 

A%«t ^UT,: J r An<l«*r^»ri m)ij« Tf*tii*\«N| fnuti «lutv in tli«* ofni^t* of 
tin- t nM«««l Mal« *• «*»ii%ul .it \ o-iina, Au^trm S*|»l«*nilii*r I, !'•<■». hikI 
ii«*«Mk' !»•*•! i«» •hit\ :h tli«- ••rt^r«'^«if t hf fniti^l >tiit«*«» 4*«iii*»iiN .it l«4>nil<in 
•iImI l.i%«*r|iia«l. I iijl.iti*!. ati«l '^n J.itiuarx '». l'***!. Ii«* %iaH. u|»on tlt«* 
rt^lUt-^l «»f til** i •>ti»m •M«:oti«-r <*«ti«'riil of linuiij^mtion An<l ii|i|»n>\ttl t>f 
tli«» s«frftrtr\ of t»o» rn'rtHiir\ . a«^Hi|;iif<| to«lui% i|i» mt*«lf4*jtl in<«|M*«*tor 
<»f iuinii;;nint<» at l..^«r|MM»l. Kii;;lan«l ll«* mjiH n*li4*\f4| fr»ini «lut\ ah 
•lu* h nM'«li«-aI i»i«»|»*<t«»r li\ lliirvaii onl'-r of AuifuM M, l'*»l. An«l onliTinl 
!«• tlif I fiit«*<l '^tat*'* f«»r tliil^ 

A«k** *^tin^' ^ ^^ K«Tr ifta'*a«*<*ik'ti«*»l to •lut\ at llon^kon^. ('litUA, 
N*|»t«inlirr I. !•••• 

>iir^ J J K>ti\**iiti Ha*» 'lirrt***! t«» |»n»i^s*«| t«i \ i«*toria, ltritt<»h 
I'oliiiiili.a. >4 |>ti*fiil»- r r. I'*»t. f«»r tlit* |tiir|»i>f%* of i n \ «*«it i|;At i ni; llt«* 
«'AU«>* of \«<«^-1h frotii that |iorf «*Arr\int; |»>rM»nH an«l rn-%1% %ih*i Mif- 
ff'rt'*! from *iiiaII|H»\ A*» a rv^-^uU of lii« ott«MTVAli<»nH li«« «uliniiti«^l 
Ibt* noniiuatii*ti i»f t«io r«-«»i«l«-ht |»li\Hirnin<* for t«*ni{Hinir\ <*ui|>lo\ nM*nt 
At iIm* \^»rin I'f Sauaiiiio ati«| < h<*uiaiiiu<«, mli«M«* <v*r\ i<*f^ %i«*n* «li%«t>n- 
ltnu«^l 111 Manh. l'"'l 

I* A >ur;; « I* U «*rt«nlii*k«*r MA». on .s«*pirm)>i-r 1<*. 1*«B>. «lin*4*tf4| 
t«» |»roit-«^| 1*1 i«al\f«»t«Mi. '!'•*% . I«»r tlii' |tiir|MMi* of mi«l«'rtti;; All i^^^mo 
hit* a<«<»t«taii« <' t«oftar«l tlo* rt>ltrf *•( •»iifT«*rf*r^ fnuii tlo* f1<MMl A U*m 
|i<tal «l<*«iAr«l Ha^ al^i <M*iit fr^nti \«*ift t irlf^Aim ft* AMi^t^t t)i«* iiM<4|if*Al 
o ln^'t 

\«kAl "^iirc 1* II i tirri«* vi.u* tU-lAiU'*! !•• takn i-li4irv«* ''f tli«* laliiirA 
t«*r \ • \liiUit at lti«liatiA|»oh«». IimI . « NlolM*r I.* t "•• 

I* A ^«irv' J A N \«l«'t:i.*«-r %ia^ rvli«'%»^l fr«Mii tlutv at MauiIa. I* I , 
(Ntolw-r tt. 1 ■•*. Ati<l onlf^r*-*! )iotii«* «»ii aa^oiint of iii«'kn«**M» 1 «io 
nil(liti«*ttal iim^IhiiI of)|(*««r« virn* A«»«»i^n**«l t<i «liit\ iii tli«- l'ltili|i|iiiir 
l»Un«U (luritit; tilt* \fAr 

I* A ^urg J U ^t«iii«-r «ia«i rt*li«*\t*«l fr«»tii itiitMiifrAlion «tiii\ At 
i^u**ln«i\ 4 AUAilA. *tu No\fmlN»r ".*»», r*«» 

^tirK II W AumIiii «iA*» «l<'tAil«*«l Ai* iiit^lirAl of||«^*r in **4»tiiiiiAii«l 4if 
tilt* l^U^iArr 11a> An«l Ui%«'r i|UArmntin«* •IaIioua, l^*«^*uilA*r *», !>■•. 



DIVISKIN (IK I'Ki;S<»NNKL ANh ACCOINTS. 



19 



uroKT or THB Dimiov or rauoraiL um Aooorart. 

By Umtu^u Pirviaxov. 



OIMMINH|o»;KI» MKMrAl. roKI^ or THK ilKII%'irK. 

At ilM» brfrinninir «»f tlip flM*jil >i*«r. July 1. VMM\ thrrt* wrrt* 107 
mHnni&MiionMl i>fl!iH*ni in tlit* mtviiy. jin<l imi utMilioiuil olllrmi wen* 
niniiiilanl€9tir<| iluritiK tht* y«*iir. 

Thr rorfipi liwt I ofl!«<t»r. \mi, Siiru. ^V. Ii. Kilaiiii, who rv«iifni<*<| 
S«*fit4*iiitiiir :f:f. VMn\. 

Twi> AwiiMtaiit f«urv«*<»tt« wrn* |>nMiit>u*<| Ui th«* k*^>^1** **^ imimril HMniiit- 
Milt nunevMitt. 

Tli# curfw nintiijitA At tin* rliiMi* of tht* flm^l \9^t cif Uifj i^nnititfi- 
Mfifit^ ofllf^ns AM ffilloviH: 

Hepirriiiair H«rf«nii-4lrf»i»r»l I 

■ai4«nt »ar«v<i»f»« t^l 



Total lot 

NiiAKlW tiiXVKNRII. 

Twc» iHmnlii hiivf* Im^*ii i^ttivrtif^l for thf* ««&ii mi nation of oOcvm for 
|in»moCHtn frt»m tlit* irniilt«of AfffuMant ntiriftHin t«i MMml nnniiiljint Rtir- 
gr»H»fi. Anil aH oflli^TN onlfTpil to f\iimiiuitifin for |>niiiH»ti«Hi hmxm 
\wk f im r ^\ midtiipfiil f\AniinAlioni». 

Two lnMinlpi mt*rf* 4*«inv«Mic^l tti niAkf |»h>'Alf*«l rijiininjillon of Afipli* 
rmntn for A|i|Miintmi*nt to |iiMiition of <*iMlrtMhi|i in thr Ii4»ri*nu«^i*iitt<*r 
^irr^ir!* ilmAnU wrn* c^invfnf*^! \im\ :?<> Ami Junt* 7, 11^*1). 

One liiMinl HAM oon%«*nf<«l to nuikf |ihyiiif*fil rtAminAlkm of StHHm<l 
^WiiAlAfit Knirin««rr H V llAl|Mn, lirvfnuni^iiltrr St*nic^, Krhrtuu^' 
A. Hml 

One* ImAnl mAA f'^Htvt*nt*il to c*«inAtilrr |iUnii rf|jiti%'<» t«i CMiUihllfili* 
iH««nt «if A qiiArmiitint* RlAtum At .>ltillr>t Kt»\. KloritlA, Novfrnlirr 
17. !!«■» 

IbaAnl mnvrnff^l in \t«fi Vork (|iur%i*yinx «l«*iM»t) for rfV i»ion «»f 
»ii|»tBly tjiUlr. (lrtf»li«<r :fl. Vm^k 

HurKMrfi AtiAlin wa*i ilt*iAil«<«l a^ c^hiiirtnAJi of a Imanl lo Im* oonvmnl 
III l*hibMlf*l|>liiA, l*«i . fntiii tiiiir> til tiuir. for ihr |iiaqioiM* of r\*««%Ain- 
luintf »urh n«jr>«*tt<«l iitiniii;rAntA a» wliouUI ApfifAl t«i it, MArrh tn, Vm\\ 

.%ii.%roMMtMPilti.%Kli orric KMA. 

Hi^n* wrrr on ilat> aI thr lirffinninK of tht* flbrjil yi^r W^ ArliniT 
AMaAUiitl »urvri>nii Ami 41 trin|ji»nir> Arllittf AAAislAlit surifrtmA. nuiktng » 

ft 



2ft MARINT->H«»>PITAL SKRVIfK. 

of the cells. Tliis defect alH^lishi-. thr I'lit-ni iiiit-na t,f rejireiieratioii. in the sen* 
that the ])r<>topla*»iu n.'iirf^lncf-' tin* r»-**»*]»r'ir> i%> a ivsult of their poscieflraan ff 
their uatnral fimctious. 

Following; one of the laws "jf biol"tr>-. thi> T^.:vu*:rat\*in is not limited totbf 
compensation of the defect, but pa8s^^s thr Miiiit. There is an overprodnakiL 
This overpro<lncticm may iin on to Mich a de«Tet." hy the repeated injectiuv 
of toxins that finally there resnlts a detaehment <if thest* receptors, regeneotri 
in excess, into the circnhition. 

(13) The free circnla tin fcr n-ceptors of the proti»plasm in the blood cx>nstitintf 
antitoxins. They retain their ririginal ])r«»perty »»f chemically fixing the hepb- 
I)hore yproni) of the tr>xin.s. 

(14) This theor>' of the pnj<lnction of antitoxins exi)laiud the great inoltiplidtT 
of antitoxins and their sjie^-ific diameter on the liasis of physic^ogical prooefiBO. 
and d(K's r.way with the necessity of attrilmtinj; to the organism an cmigmiiticil 
inter\'ention. 

( l.")) According' to their origin the antit«>xins Imve a purely chemical relation to 
the toxins. The two Ixnlies unite to form a new substance indifferent to the 
organism, as has b<'en ]»roven by the work of Fra^ r.Ehrlich. Cherry, ^lartin.etc 

(10) It follows from an exliaustive study of the conditions of ueatralizaticm of 
the toxins by their n-sp^K-tive antilKxlifs that jxiisi^ms contained in a boniUon clo- 
ture, esiKjcdally those pro<luce<l by tht? bacillus diphtheriie. have an eztremelx 
complex com]K>sitioii. 

(17) Tlie ba<^dllus of Loeffler ]»ro<luces two kinds of sulistances: (1 ) Toxins. (2i 
toxones, lK»th of which have the i»roperty of fixintc sixrific antibotlies, and poaaev 
in conwjquenct} the sjmie hai>to])hore ^^rouj). On the c»ther hand, the toxqphoR 
complex of the toxones exerts \\\Ktu th<* orjL^nism a feebler and sensibly diniereiit 
a<!tion than do the toxoi)hor.* gi'oup of the toxins (absence of the power of causing 
neuroses. pnKlucing lat**r ])aralysis. ) ( Madsen, Ehrlich. ) 

(IH) All lK>uillon cultures of l>acillus diiditheriiv contain in addition products 
of the modification of the toxins. haWn^ no toxicity, but ca])able of fixing tlie 
antiluMlies. Th(.*se are the toxoids. 

The origin of the toxoids is due to the fact that the complex toxophore of thf 
mole(!ule of toxins is much more unstable than the ha])to]»hore. and are destroyed 
umch more rea<lily by cheini<ral and thermic agencies. 

This oliwrvatirm is of particular imjMjrtance. fnnn the fact that the fluid i>oifio» 
of di])hthena s]K;nt5im*ously weaken in this way — that the toxicity of the bonillaii 
is de<-idedly less<»n(Ml, while*its ]»ower to neutralize antitoxin is jwrfectly preserwd. 
There is a quantitative modification. 

( 1 J)) We must a<lmit the existence of several kinds of toxoids, corresponding to 
their difl*erent ori^ns. S<;v«Tal fsLcta seem to indicate that having l)een given the 
com]»le.\ity of con.st ruction of th(* toxophore group the complete destruction of the 
m(»li'cule of toxin may take pliice gradually, and that if a suitable treatment is 
<imi)loy<'d it is ]xis.si]»l<; to o1)tain t^ixoids having a ]>artial toxicity. 

(•JO) It follows that it is ]>os8ible to jjrovoke the i)roduction of antibodies, not 
only by using toxins, but by using toxoids as well. In fa<"t it is possible readily 
an<t ra])idly to immunize animals as susc(>i)t.ible to tetanus as the mouse and guinea 
]»ig by administering toxoids only. 

So tliat. wlicn sick individuals who are very sus(u?i)til>lc ar«» to Ik* treat^nl, toxoids 
will have the vi-ry first consideration. 

(*31 ) KurtlHT ex]»enments liavo shown that the two groups toxo]>hores andha])- 
tophores of th<i mole<*ul(j of toxin an? also found in certain ferments. 

The liyiM)thesis of IMorgnirotli on tlui existence of hai»tophon» and zymophon 
group in th«» lab. fernirnts has bcrn r»*rently verified by Myei-s & Bash'ford. who 
hav<» <lis<'ovi'r<Ml tli<* zynioidcs aualagous to toxoids. 

('2'!) Thr most reci'iit rj-scjiTch* s tn-ating of a new cliu^s of important cellular 
]»oiHons. r<'i>resrnted in ])arti(nlar by the }>jwt<'riolysines, the li«*rmolysines. cyto- 
ly^iiH's ( IMrilb'r. Hordet. LandstciiMT. v<»nT)irgrm. Met<*hnikoff),have shown that 
lln'se poisons have a v«'ry com])h«x coniiMJsition. 

CJo) Tin* fad tliatth(MiiinninitylMMlirshaveaspeciti<r affinity for the cells (bac- 
teria, rrd glo])uh's. sprrniatozoids) that w<*r(» us(m1 to immunize the animal is 
explained l>y llu' theory of sid(* chains, in admitting th(» existence of receptors 
having 1 wo groups jjoss^ssiTig attinities of dilT(»rent coml)inations. 

Till' immunity pnnlnced by l)acteria and by antitoxins Inis many points in com- 
mon, aiifl finds itscxidanation in this tluiiry. 



M \Ki s> ii"-ii I \i. -> i;\ ii I . 



'.•*.• 



WW N ■ ? \ 

Mf»» r • liiJ«K.i«irt* ! t.t ?.■••**»!* f ••■ •-^•!.:» • ^' •¥» k:T. S ' :iitii. .!.;' « 
I \'«ftir.tl iiiiiti-.ii.i* % •..•^'•.r.i' ft •:••.»!. • 
II *^I«« :fi :ti!iii iii:* % 
• if ••■. ■••..f- S'.ft''ir.». iiiifiii. *. ti •;• • ••.. .iM • \r I iutxAft 

"f !!:• ^li IM.- • ••li!a.li<«l * *.ii* '••S ;•;: •- .•'.I I'l • r'^tlli -IN ■•* Mm- 

■ f t)i*- f.M * 'f..%* tl.- 4l<«ii.-<f **.• •■ r-ii:i .•?• .k'l>«iii.«Ti "t,\\ II. • t- • {•! 1 ri.il 
!•• • t;«l • '. tr. , ! • 1. lu^' ■ * r- • ■•.!• • ".• ;- •..!• !•• f f >...►•-. ti f !*!• 



1h- :r r .:•. ■ ! ■ ■ - % r. - 



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30 MARINE-HOSPITAL SERVICE. 

There ;ir<' no specifii- bactericidul substance's, no s]»efific hemolytic Biibstancea 
In both cast's we have to do with a combined action. That is, the bacteria and 
erythrocytes are prepared for the acti( n of the normal alexins by the specific 
action of the antibodies. It is a matter of indifference whether the alexins are 
produced by the same species of animal in w^hich the antibuiies are produced by 
specific incK'ulations. 

This preparation of the erythrocytes consists, as can be shown, in the specific 
hemolytic immunity, in the attracrtion and loose combination of the antdbodies 
with the specific erythrocytes, in con8e(iuence of which they are dissolved by the 
normal alexin. Probably it is the same in the working of specific bacterial immu- 
nity. It may l)e affirmed with certainty that the action of antitoxin in neutializ- 
ing a specific toxin is due to a mutual combination. Accx>rding to this theory the 
true principle of specific imnmnity consists always and in everj' case in an attrac- 
tion and special combination between the antibodies and the object of sx)ecific 
reaction — toxin, bacteria, erythrocytes, et(;. 

The enigma reserved for the future lies x)rincipally to find out the natare and 
origin of the antibodies: in addition also the exact nature of the specific combi- 
nation which takes place between antitoxin and toxin, antibody and object of 
reaction. 

CONCLUSIONS. 

"Natural resistance" and "specific immunity ' dei>end upon different princi- 
ples. The first is chanu^terized by an alexin, the latter by the specific antibodies. 

The alexins are killed at 60 . They differ according to the animal species which 
prtxluces them. They show no attraction for the object of reaction — i. e. , the 1mm;- 
teria, erythrocyte, etc., used in the inoculation. 

The antibodies are not destroyed at 65 . They do not differ according to the 
species of animal which produces them, but according to the reagent used in pro- 
ducing them, and they have a specific attrac^tion for this reagent, ^vith which they 
combine. 

Alexin and antibody exist in the organism at the sjime time and often 'work in 
combination. Natural resistance and specific immunity can operate in the same 
organism at the same time. For iTistanco. the cure of a case of typhoid fever can 
be caused by an augmentation of tlie natural resistance concurrently with the pro- 
duction of the specific antilxxlies. It is the work of clinical medicine to diagnose 
and differentiate each of these conditions and changes. 

METCHNIKOFF ON IMMUNITY. 

Enlarging upon the general conception of immunity. Metchnikoff. after having 
shown that the most general plienomenon in natural and acquired immunity con- 
sists in a phagocytic reac^tion, stated that he considered that the immunity of 
infectious diseases is but a particular instance of the reab80T'X)tion of former ele- 
ments that takes place generally, and that the i)hag(K;ytes act in virtue of their 
sensibility and their ])ower to ingulf and digest these formed elements. When 
the body is in a refractory state (st^ite of resistance) tlie microbes are never elimi- 
nated by the emunctories; they are always disorganized, just as the old formed 
elements, such as the leuccx-ytes and other objects, are eaten and destroyed. 

This dissolution is in fact a true pro(;ess of. digestion, analogous to extra- 
cellular digestion. Here, just as in the inferior organisms, the digestion is intra- 
cellular. 

This intrac<'l hilar digestion is accoui])lishe(l by aid of ferments, among which 
cytase occu])it's first i)lace. 

The cytases liave their origin in thf loncocytes. They niay be prepared by 
making an emulsion of the marrow, the spleen, the lynipli glands. A cytalytic 
fluid is thus ol)tained. whi<'li is destroyed by heating to .">() . 

The cytase in the Ixxly remains c(»nfiiie(l in the phagocytes and does not diffnse 
into the ])lasnia. Tliis diffusion only taki's place when there is a destruction of 
leucocytes or j)liagncyte8. as. for example, in tlie serum about tlie formation of a 
coagulum. 

As a rule, the cytases Ccm notexist alone: they need other substances. They are 
aided in their digestive functions by a substance more resistiint to heat, i. e., 
])hilocytase, analogous to the substance intennediaire of Ehrlich. This philocy- 
tase is the product of the phagocytes which is most oft^'u excreted in the plasma. 
The presence of this ]>hil<x*ytase is not. however, necessary, for not only in natural 
immunity, but in certain cases of ac([uired immunity the organism can resist 
withtmt the ])resence of philocytasein the bl(K)d. 

The antit^)xins are then, if not entirely, at least in part, the products of the 
phagocytes, which remain the true agents of immunity, both natural and acqrdrod* 



HM % II I % 

t^m\mrmti r«-jMl a r«'|B>ri iit»*ti miih* .tf th* <»iI«aim«^ luiMlt* in thifi iiiit«*rli»nt m%%\^ 
|«^ t Tit" f«*|lit«ttitf I* m •iiuitii.ir^ 

Thf lM*tiiAiii<i-lfli iiuit«ri.i* |>r*<«fii» twi* ««rttttt« whu h unt\ }»' i «ll«^l |«ir^a 
aihI maiTTui. Mf ^•nlliiK t<» ttw «liin< ti»Mtt« < f tlu- |«inMtr«« 

Wh^fi « tiuilaiuil iMiiitfit li»» t>i«* ■iiiaII « i»n*T « ■ tM»r« .« ■ tii la* Itl***!. «••> tti SftH- 

tfftl. mn»\ r«*tnrfi« !•• r rmiM«* ai»<I tli«*fi •wiff»-r« > ri-Ut***- < nttuinU tlit* Urifi- van«*t% 

nuHnui • u n'*w f«ititii| tn hm t»|.a«| Thrr^ f*<r«' tl»«^* an* tv«l (liAnvnt •{m-hni. Imt 

«An«>lt«^ • f thr «Ml|r |flinw»ttr 

Th«* tt« Mm |tK* a|i|»ll<*al»l«* t«* tht •*ii«l\ xf tiwlan^ * a** iit^tt- n«>ial*li* iin«r««»i|iir 
tii|( tlf |Mi»t >«-*r« K«" h. /t«-iiiariti S*m lit ati<l |{ti);«* liji«i< |«-rfn-t«-«l thf tiit-llMal 

• •f ll«iti».iiit>iK«kt I^%«r»ii Ima oh 'Wti tk iiM'tif*! 'if •taitkttiic lli«* tun l«*t itf th** 
hjmuil<'<- ••ti III Uh* r«^l « «*r|»ii« !•-« iti<ir«* •«*n«iti iititl •'%mu'r !h«n th** • nintial *»r 

tl»i«llft««l tIM-lhial «if K«>tll«tHi«l«||t 

TIh* rv « .ir Ihv «>f ^«ltll<•tl<l |W >■ h-«ii'lttitt -in*! Nii^llf* ki ••! f •' •••r»|th«i hjt^* 

• Umrv^t ii]i ih«* ititii h ill** ii*«M-«l f|ii«^*t*>ti xf ?tjt«:« Il.t *-f '.\f h.i-iiii»t.t/*«iii iii«»li«rt.i 

It i« iHiw WiHiWti timt fh«* flAir« ll.i an *K« iii.il*- • i«iii*-tit« <l*-«ttti*-«l !•• f«^ litiilaTt 

IIh- f«-tllAl«< fIs'tlH-tltfi 

Th** '*tMrr««ti*itia '-f M« t 'nlhiiii « »|*ti*- K«* h n^uA Jklan h'-ii l*4i\«- ii*> •I'MiM i»fi 
tf thv* r tlo* of tht* ftniO'l^t ]ti««i|t|ti«*fi »>T 'hirt-tivr.it*- fiirm* ••' !h«- h.* fti;ifi'«'>iti !•• 
h'4 thvfi t-iut 

In t<«F«| I^rarmn *;««•• ••nt thf h%|»>ttH«i« th^t th*- // »..M/«frMr i« fotm*! ••tit*i*i«< 
th«- htiin«n **rif«iiutfi »• u jMr^Mt*- !■: th«- tii<«te|iitt'> Thi* h>i»thf^s« hA« fp«ti 
«*-rtlW«| h% KdiM jin<l ««*ntiriti*«l >*^ n* >fi\ •>>««• r^<*r« K«« h (irAAoi Itiiirvuitiii «»ih1 
IU-ti«nrUi 

All thf* aiw>|4irlr>« w'tn t • lia\« ^h** t><w*r !•• |<r< •t««ic<*t«- tiialAriA li< tiMii« 

|iL^«-« f th^uitrSl thf* •'• ti«t*-t» f tiiAl^rui aiitt an- •|*hvl«** ha* **«-fi t «i||firtiir>.l 

4 t»i th«* i>ititrar% . in hfulthv u\jk - « • t}!\ • ili-i *iri f" I'A 

Tt^f ati<i|»h«-l«-« th*-ti M hi h } a\«- •''IT..; .1 iii.tlan.k! (•-r«i -•> < a.'i )*.?•'•* h«-a}ih% •••••<• 
Th- iff*mi« hl^**. ^ i' U •*»* ar*- 1 ••»•• ! 'ti ?*»•• •^.il!%.ir\ «;L»!i !• ' "'i- h ah :!!*•• ! .it I 
ax*- ii»'« tiljit'«l wifK *K*' « •••5-.: f". \ ti tii ■ -.i!:*. Ar\ arLiTitl* ?• « *.-. •.•■n i . 
ant»i>tiri«-«- \tukl iiiaL»nA :• iiI v» .«> • • .irri*«l : -i f hi« «« .i\ 

llAl«na i*«»ft«-fi • *'iifr.»- t***! i*k u*.:;i).a'o!*' I !•• .it'.*i*-« Th*- f« t *i.at th** Innitni; 
np 'if fb«* » ill aii'l -tf I hillirirf "f** n ■ ■•»i«»-« r ^ r»i !t^.«iM'»'« "f * ii<l«*itit« i«ilM*li*rn »• 
*l«i* «lifll« tilt t«i • tiilaiti if Wf ««lti):t tlui*. ittaLirtA t a*w,i«« !ii>« iil.«t*^1 ^« th* 
•titiif of aT»ii|«"I*-« Willi h h4\ > •«i> ki«! inalartal M***! 

Ahh<iti«ffh • • rtaiii |«'irit* iir*' •".II ■ * -i '!*• th«n u tf«i ?«• itxti! t t)»a! a« f ar a* 
th«- pr'-iiht Laitv'f nialan^ft t* i xt.* • *i • •: ti.« a ur* « t<> {•r«-ft'<i • .la^'intt^t t|it iii-MW|tiit«> 
ar** -f tfif fir«t '.iitiB'rtaiit f 

It !• Ki(;>>riaMt alik ' III • f«l* f t' j»f» \* » t r " rM«l«^ • im"»^«? m^Urta »•' oM iii4r%li) 
r»-i:v.f»», t ' Ktiafil thf •!. k atfAii:-? •!• I .» — f th. .■•, ••■;.-• 

K'« h Lmi iiia-l* • Im* r ^a*.t ii* ifi %fri i fA\<irAtil«' t** f (.*' • ti»trf f aii itutuiitilf > 

a* vium*! l»> th*' tiat I %f««.f iiiar<ih« r i;i ti* riii* ; nr ti t • i* thf r*««ilt ^f atta« k* 

• •f malaria •Id n tiff >• •tit h \f.tt:^ f »■*•«:••« 'h.!* t^i- : »f %•• ■' k fnar^h> I ••*tiitr . 
fr%«|i»rtl*I% l;a%« •••hfiia r.»*h*' *).uti th*- 'rtif .» ti*- « hi'i '. iti«;ariui li«l! t!i « 
ti-wm WA tiifrit th** liAlitf • * :liiiiiilli:t-. 

Th*- al1«tsi|»ta iita*!*- t*i •-•talil;*!. afi ar*i « \Jk\ t ti'in* '.' \ a.-^'ii** itiai^r^^ '.^^k*- •>• 
faf faiWO 

Til.* •(i^>>«« t Ha* ahU tr»at.»l l.% |t.*".l Tl.- '••II %»!•:»■ »>ti.ii»ari 

M* {••llitr^l ••t|t that r|>|(h* '.\^\ * uli' «-r» aff uU-^f a!l ■ K %tjk- t* ru *) ' '.-'■ ) fi f 

at ■€* f ll*»- * t<ITh*-l'a! • • 11* .n I up t • I.. |. • • •.• "in • .. •«.«•: tn ■• •. •♦ i. ••■ 
•.*»• fl** |».»rr •►f |if«-lu. ui*; Ai. ^'-ti ri:t.«l |r' I f" f^»r-'«. ..f . j,i*» . .:..ii; 

\%'. t*til% kt***w tl.at li^«l*-« . f •! •• i.at'ii* f 'h* r. *-'.•!. ri.i . at; !• | • -I'l « 1 • '.t 

it I. «■ (Mit Istrft |»f«i% I tt tll.»t tl.f tf f"*t^ -f 4 • • • •! % ' alt trixr tr '!«- • i-i'l:* it • ! *• t ff* 

- at^ « ff 

Tlarf* IB ^ ^l** tal f « •'". '.if : *. * t!.t • j-i' !•.••, il . • ^r. I • •• •? * ' • |*«ri»'i'* - :!i 
all ' *i»-* •■# «ati rt 

Tl»4tia* flr«l •h*«iaf*l tliat II.' tt*;*ir« • rfi^ • '• * '>'i; cr* *i. •••.•• r v • f ■«.ili»Ar« 
•-# aH* i||«-<llM-f aii-*th*-r Ikat«ir« I'h* r> **:•*• ii.v-a. • ll-ilaf • lti*l>>* - i-r* •. t.*.t.^« 
tl«r f-HTtii • f nitiii'l I*b1|«« • f t.f It •ff.ti • I;*! .t* •. 4< !• • 

Ths* %a» u«4l«aii<'ti t« fr«ii|tk*ti* .tt .ii't* ' /!)i<tiilir •••:^ii «* .; 'r'>,>. *.' i 

• < «#-S* nw^t Bt»i|i iia \m f--ijf.»l t!. •/ r !t»r»' • Wi'J. , ■.. M »i.|,«i.,-.f "SiVk t.- • k ■ 
MM»lr ••4uiMirall%*- •t«i«li«-« •*' tl.' % »• 't- '• • ..f.-l 'f .-• f ti.« «• -tt.,,' -f A.:* • • f t>.« 
«••« lillA f«r IIm* nil>l<lt Thf |iart»»it* |/ri«»t.S«l l*<^!r ■ f tt !.• •! ;i. tht f- flu tf ai. 

tUm MgMl In • « AL't^U* « hU h o!U U 1 1 •UlallM^l Uiu< ut 



Si MAKINK-IKiSPlTAL SERVICE. 

A' '.•."• 'j.z.;^ V. J^.T'i^fr t:-«?r<r ♦xistH a^aiii an aty])ical evolutw»n of the canotTwD- 
-y '.'j*: fc'-rA'-r: .\ »>;•?. «-r': -^^r th*- i<li^»soiiH*, ami Sawrhenko himself luis abandnord 

7' J*- T'^ ^'.:*\\ 'i"v«-i«/W:*l tljM^ry that fau(**r is <ln«' to a yc^ast 'waiK carefnllT 
•'*-v..-vi-»r. T'r,: 3- the r;laf-t/miyr«'ii<' tlHMjry. 

li'-'-»»- ;j»- »-h '/•*-: J th«r (I<fV(;]o[im<'iit <.f a tiiin<*fa<*ti(m of the skin under the 
*•;*: •j'^Li' -^ '.* a /••si^t. jfi C'tirtis hIiowimI in liis study on the sa<*charomyces tmw' 
to^'.-'j^ix*- ■ -'iV:'j:an«^/T:h. ThiH in tnnn'fa'-tion — not tumor. 

rxx:. y\',i*'^. PJ'iijj«:r. ;;iid .Saw<:lj<*nko admit the blastomycetic theory and inter- 
|.r*^ 3^, Y^-urtr all tl;«f 'ild i'y^nr*'H d<.*s<TilKd us anid'ba. 

3ti' V ^.■: and ^alw> liav*- hhov/n tliat yi'Jists which have l)een isolated from turn -ff 
ar*: «';j.',*'tii/j«-'' iiii?inriti<fT from a s r mdary infection, or even from the air of the 
latx-Tat'.ry. 

i>.'rr<rl ha^ v.-^'Il hhown that th^t inoculation of a yeast is accompanied by a reK> 
I'yrti whi'h mav <rnd in th'* fonnation of <*i)ith(.dioid cells, but not epithehal cel]& 

Th* r.h: ** x..^' v'rartM lias 1j*^mj st udied !»/ San Felice, by Wlaeff. who obtained in 
wrviTfcl <:aM-«» out of nuriM'roiiH e:] erini«*nt.s a tumor rt^sembling adeno-caicinoma. 

Jii ti.«- '»i/Li'.n of JJ'/rn.'l up to tin? im-sent time neither the bla8toiuyoCtic origin 
w:r \\a'. yAif:U:ri'A\ '»ri;rin of ^-jin'-i'r lias b<*en ])roved. 

\^ift\^n*\. of |jn*^^l''ii. n;ad a i»ai»«*r (;n the blasts any cetic origin of cancer snd 
hh'iwi-d an or;£ani'-m \y^-\* twwwa, to tho moulds, isolated by Dra, and foand in the 
u\*^A and i^th'ilo;cic;;l tis«>ne. Jn th<* dis<Mission Metclinikoff expreesed theonin- 
\*fii rljat. *:ontrary to tli*- views of L<*oT:ohl and Bra, ho l)elieve<l tneir work rather 
;<rov«'d that tlie or;ranism JM^lated by tni-m was not the cause of cancer, becarsethe 
tuiiiorh \iT*A\V'*'A in tlieir ♦'Xixrrimental work hav4? not the tri.e epithelial character. 

Ti:»KK('rL<»sis. 

Very ini.en-Htin>< ronrdusions an- drawn by Martin and Vandremer in their 
htudi*-'- of jM-riToneal tiilMrrculosis of the guinea i>ig, .showing the way tnbercuhr 
I^-rit/;iiiti»- may \n*. pn-vent^j*!. and giviTig tlio rationah? of the cure of this fonnn: 
th" di»^-aw; 

M tuli'-rcl*' Ui^'illi ar<' injf^rt«'d into tlie jKiritoneal cavity of a guinea pig, theiv 
a»^ual]y r'-H»ilis a tu]><;rcular ijeritonitis. with the fonnation of readily visiUe 
tuU-n-J'-t-. if a hnjall fpiantity of a youngcultnre is used, this always happens. If. 
oil the oth'T hand, a lar^e cjuantity of an old culture of tubercle bacilli (at least 
¥\x months old; is inj<r<-t<Ml into the ]>critoneal cavity, there results in certain cases 
death from r-achirxia. and at the autopsy no tul>ercles are found in the organs, or 
\i'ry fi-w an- found, not suflicient to explain the death of the animal. 

Of w. «-fj r-iiltnri-s <-xam iwd the authors were able to find only one of them that 
alwayh It ills the guinea pig rajiidly when a large quantity of a six-months-dd 
ciiltnn* is inj«rt:t«-d into the ]M*riton(?al cavity. 

Th«'y tjjink that th<r mit^olxi j>cts by its i)oi sons, and that the guinea pig soc- 
ruml>s to a true intoxication. This is the more likely, since the culture which 
gave th'- most constant results was the same one that in previous experiments on 
tiili«-n-iilar meningitis and in the study of the iM)isons of tuberculosis gave the 
largj'st quantity of thc-c; iH)i.^ons: that is, killed a guin(;a jng in less than twenty- 
four hours when 0.1 c. c. (;f a three-months-(dd culture filtered through a Cham- 
)M*rlain ))oiig!e wjus injected into the brain. 

To verify this hyiM)tlH'sis Martin and Vandremer sought a method to kill the 
bacilli without d(^stroying the poi.sons. This they accoTuplishcd by treating the 
bacilli with ether. 

The tulMTch' bwillis must remain in ether a long time in order to l)e killed. 

In order to be certain that all are killed and to accomplish this more quickly it is 
necessitry tr) first wji>h the bacilli in etln r. then dry them, then replace in ether. 
When the operation is Wi'll done, all the gnmnions substance disap])ear8 and the 
bacilli form with the ether a true emulsion. The <»th<M* is again evai)orated and 
the mi<*r<dM»s dried and diluted with wat(?r inji'cted into the peritoneal cavity of 
a guinea jiig. 

The eth<»r has another action — it dissolves a part of the tnlxTcle bacilli; that is, 
tin? fatty material. If examined unthT the microscope after three weeks in ether, 
more th.in half the niicrolM's do n< t stain by Ziehl's method. These biuiilli. dead 
and deprived of fat. still contain the poison, but all traces of the organism do 
not cont^iin an erpial amount, and it is not po.ssible to surely kill a guinea i)ig with 
all tnlM;r<-le bjwilli treat <k1 with ether. 

With the very toxi(r micr<d>e descrilM'd alH>ve. the results, on the contrary, are 
constant. The tubercle bacilli treated with ether and injected into the x^eritoneal 



M % III .N>.iii>^ I'll \i. *-! i:\ ]i y 



'M\ 



iBiiM I'f ^'iiitit w |is«:* kill t!ii III 1>\ • .v K« I • ti .1 « .tri.!*'!' '-ii.< ■!• ;• T.'tii.i; *i|a 111 iIh' 

W-.' h «• ••'• t:r«iii "f th*- liii< r*<)ii«*li U«)it - ii* ,:'r.ii« .• yx,: >li* - :r. *• f ■ ^ • ;*;(•* h- >iir«. 
mil •• '•! t?ri*iii II ili«« 111 « U'lit 'U>- \* ;?K '• " K'fulii ;? 'Itt * I ■•.iii-t.M. ir:»h •' '»-• 
[Tmiii It «li*^(i III "11 iiii« li* 

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34 MARINK-HOSPITAL SERVICE. 

Tlihy cnltivat»wl th*; organiflm on iK*tato bathed in 6 i)er cent 'wateiy £^lycerm 
M .1 ijtioij . ^nn*i roloniej* take the f att y . bulbous appearances. By cultivating thoe 
'•''3'/ij3<-*t they finallv arrive^l at an organism ha\inj< the characters of tlie tubercle 
t0saf rill xin *>f binl *. 'The youn^ l»ac)lli of these cultures decolorized very readily with 
a"]di». Aj* V» vimlenee, this also was iuridifie<l. The organism no longer gave the 
%'illeuiin Xyy*'.. but the yenrin tyfie, and became verj- virnlent for cbickens. 



HKiffia OS TiiK ri{'K;KKi>iN(is of the Commission Ciiaroki> with the Bevi- 

KION OK THK "Sf >MKSt'l.ATl'KK OF CaTSF-** OF DEATH AT PaRLS, FRANCE, ArOUST 

(Bertillon <'lassifiration. ) 
]*>' P. A. Surj;. M. J. K<mK\Ai'. VW»-I>n'Hid<.'iit <»f th«* Commiiftdon. 

Pauis, FR.VNCE, yovcmb**r «?f>, 1900, 

iSiK: I have the honor to submit herewith my reix)rt upon the "work of the 
rofiiiiiihsion c-harge*! to revise? tlie nomenclature of the causes of death. 

'i'his nomencrlature has Ix-en recommended for general adoption on January 1. 
JiMil, by the International Congress of Hygiene and Demography, by the Inter- 
uational Statistical Institute. ])y the American Public Health Association . and hy 
the Int^matirmal Confen-nce of State and Provincial Boards of Health. 

Tliis int^'mational revision, which was largely brought about by American 
registrars, has alrea<ly Ixn^n adopted by the following cities and States: Maine. 
N<-w Hampsliire. Vermont, Massachuw^tts. Rhode Island, Connecticut. New^ Jer- 
w;y. Pennsylvania, D«'laware, Maryland, District of Columbia, Michigan , Indiana, 
Minnesritii, Colorado, (?tc., (Greater New York. Boston, Buffalo, Baltimore, Savan- 
iiali. C'olumbus, Milwauk(re, Dubuque, Tole<lo, Washington, Charlestcwn, etc. 

It is iiij]Kirtant that all these States and cities use a similar translation. I am 
informed tliat some of them are waiting for my official translation, and I have 
therefon; to resiH'ctfully renuest that the report l)e printed as soon as practicable, 
in order that it may ]m; ready for use for the stiitistics of lfK)l. 

I hav<f also to resiK'ctfully rtKrommend that our Service adopt the nomencla- 
tures in i)la<'e of the antif^uated one now in use. 

Very n'siiectfuUy, M. J. Rosenau, 

l*(if<s«'d AHHiHtant Surgeon, Jf, I£, S, 

Si;K(iEON-(iKNERAL, Marine-Hospital S(^rvice. 



[Tj<«t1<'r of triiiisiiiiltul.j 

Paris. France, Noveni1>er /, J900. 

Sir: In compliance with your orders of July 10, I have the honor to state that 
I attend<Ml tin* m<?etiTigs of the International Congress charged to revise the 
nomen(;latur<i of the causes of death as the official delegate from the United States. 

The conmiission met August 18-21, 1900, w^ith representatives from twenty-six 
countries i)resent. Tlu* work of th(^ commission consisted largely in revising the 
old system of nomenclature devised by Dr. Jacques Bertillon, chief of the bureaa 
of municipal statistics of tin* city of Paris. Although many changes were made 
in tliis old svsteiri to meet th<' iiiarcli of j)rogress, nevertheless the nomenclaturo 
as ado])ted by tlm commission is esseTitially the Bertillon system, and the credit 
and honor is due I)r. Bertillon, not only as being the father of the nomenclatnie, 
but for th(» great industry and zeal sliown l)y him in bringing about international 
uniformity. 

To American registrars, in particular Dr. Cressy L. Wilbur, chief of the division 
of vital statistics of the State of Michigan, belongs the credit of being most active 
in bringing about this revision, and in suggesting important improvements. 

Inclostul is an extract from the proceedings, whicli shows tlie part taken by our 
<"ountry. Thesi' few ]>ages fr<an the proceedings also iiulicate some of the difficul- 
ties that confronted tin' <'oninuH.sion composed of meml)er8 from so many parts of 
tlie worM, s])eaking so many ditferent languages. 

Tin* work of the conmiission. as given in the finished nomenclatures, is by no 
means ]M*rfeci. Tln^re are two reasons for this: 

Kirst. Tile clas.si(ication is based on the si'at of the disease and not its cause. 
Me<licine IS not y<*t a suthciently exact sirienct* to gather mortality statistics 
m-cording to the cause of the disease. 

Sec<md. The nomenclature is a compn>mise. This is a necessity where so many 



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36 MA RINK-HOSPITAL SERVICE. 

Peru. — Dr. Teobaldo Cancino: Dr. Pablo S. Miinbela, chief of the medical dv- 
Iienwiry at thtj University of Lima; Dr. NeuhaoH: Dr. Antoine Peres Boca, pro- 
feHHor at the University of Lima: Dr. Armand Yelez, dean of the Faculty of 
Me<Iicine of Lima. 

Purtuyal, — Dr. Ffjrreira de Mattos, jr.. professor at the University of Goimln: 
Dr. Jean de Mello Vianna, member of the Royal Academy of Sciences at LiaboB: 
Dr. Charles Leopjdd dos Santos. 

RuHHia, — Dr. Basile Grelx'nchtchikoff . conncilor of state and agent of stam- 
tical and epidemiological affairs in the department of medicine; Dr. Alexandre 
Timofeiew. chief of bureau in the department of medicine. 

liepublic of Salviulor, — Mr. Rafael Zaldivar, minister plenipotentiaTy of Sal- 
vador in Paris. 

Sweden, — Dr. Wawrinsky, councilor t<j the royal medical administratioii d 
Sweden. 

Switzerland, — Dr. Guillaume. director of tlie federal burean of statistics it 
Berne. 

Urguay, — Dr. Alfred Navarro; Dr. Henri Pouey, professor at the Facnlty d 
Medicine of Montevideo. 

Extracts from thk Prockkdin(is of the Commishion. 

The proceedinKR in wliich the* United States took a special part is hezewitk 
reproduced. Wliile there was only one official delegate from the United Stain 
l)reMent at the meetings of the commission, nevertheless its work received am- 
siderable attention from American registrars, wlio communicated tiieir opinion in 
writing. These suggestions receiveil the careful consideration of the conuniaaian. 

TUBERCULOSIS. 

M. Bf^rtillon (France) spoke against classing all tu1)erculou8 diseases together. 
but i)referred to i)lace them under the heading for eacli organ. This arrangement 
would enable one without difficulty to know the total immber of cases of menin- 
gitis, for example, which is very usc^ful, for among so-called ** simple meningitis" 
there are without doubt many that are tuberculous. The same ohservatioo 
applies to peritonitis, enteritis, etc. 

Dr. M. J. Rosenau (United States). — The prime importance of tnbercnlooi 
makes it indisptmsjible that we may l>e able to read from a statistical table, with- 
out difficulty arid without collecting and adding up widely separated fi^^ues, the 
total number of persons dead of tulxrculosis. It seems inadvisable, then, to sep- 
arate tul)erculosis under each rirgan a d tlius divide the facts in many places, at 
is done in the nomenclature of Vircrhow. Mr. Rosenau, therefore, was opposed 
to the proposition of M. Bertillon. 

After further discussion the commission decide<l by a vote of 12 to 8 (2 absent) 
that tubercular diseases should all l)e gr(mx)ed together Iti the same place. 

(^liOLERA ASIATICA. 

Includn under this hea<ling, Indian cholera, cholera (without classification), 
cholera morbus, and epidemic cholera. 

Ch(fln'(t vttsfras.—Vr. M. J. Rosenau explaine<l to the commission what tbe 
sanitiiry council of tlie Province^ of Quelx'c and other American physicians had 
previously suggested, viz, that in Ainerica "cholera morbus" aoes not mmn 
** Asiatic cholt»ra." 

M. Brouardel (France) thinks lliat the expression cholera morbus, formerl]r 
used to signify (rholera iisiaticji, lias become infrequent. He thinks therefore that 
the words "cholera morhus ** maybe omitted from the amplification of the heading 
Choera asiatica. This would permit each country to intijriiret this expression in 
conformity with current usage. 

(Adopted. ) 

SMALLPOX. 

Include under this heading variola, varioloid. Do not include varicella. Fre- 
quent complii^ations, meningitis, endocarditis, suppuration, albuminuria. 

An American physician suggested that ** varicella " l)e ])laced under the heading 
** Variola; '* <leathH from varicella can be <'onnted without error as due to variola. 

Mr. Korosy exi)ress<*d an analogous opinion. Varicella, he said, never cansee 
death, but when tliere is a death, it is really variola, and the record should attrib- 
ute d(>ath to this disease. 

The statistical department of the city of Vienna was of the same opinvm* 



1IARI!«IC-lifMrtTAt. HKKVirK. 87 



hf Mr fl«- K'f^w) Karv* aa iWaiIi* fr«*tii «Art<t>IU mr^- tbrv mn* «t|iiHliiii*n 
with Th«*> hATr omal«lrnil4«* ltii|««nAnf^- in loimirw** Mn^h mm flf-niiMiy. whirb 
mn* wfil |ir«'lM-tf^l «ff»lti«t rArV*!*. f«»r it nM<«ii* mtx-h !«• kinfW wli«Uw»r i Wat in 
(wbHhf^ «*cir iir t««ii an* ff^«n VArWiU «>r tatii^Ua. 

Mr Wonlmncrr i^iifBflnl u> truun thr t**it. 

(Trit timtntalowl t 

<*niKII KftlHEIIIi l»l«llit 



/1<i4/«*# — I>r. M J lUw-tiAti 4 rmtml HUttw» wtn%M Hk«* In •»«• OMlr In Ui«* flf«| 

••f lilt* rtkAiiiicuU lj>tfw-nr AtKl in i^^Wr tn kiv** titir WAmtnjc tluit m |Mirt **f i-i>«siitr)r 

ki»i»wfi 

M lli*rttll<« • Krmiii>r |«r«i«*«vift t«> lr«ir«* to r^i-h <^miitry tiit«-r«^tr«l tin* |H*niii» 

■(N 41 til |i«lt thi* l»r«iltffi|r Itl tiM* ArM « l»i»lAi Atl«4l A* Wfll A* III lt« Wrrkh fV|BirU 
l^it t«» A %«4«- tin- |»r«i|»Mitt<4i «>f M K'MT^uiti WA» l(Mt r» Mittm A|C»tU*t .1 

t^l»r%,m^ I>r M J KiMPtkAii rtiiirvl StAl««'. I^-|mi>)r t« \f*ry mn* in thr 
C*nitr«| HiAt«« T1b«>rr a^* ««-ry frw <l«mthA fn^n tliU «li«nAM* rAth yrmi lliiwrvrr. 
In «ir« iif lU tm|B<rtAO««" iIm* ii|ar«krT i« in tm\%it «*f maliiu^c a »|v«tAl Kf^tltmr ft*r 



^TT-i, 



lik-i|nMi llmill<4i FrAAt* think* that thi* t« t^A Xfty n«»fnl a* mm-h 
cvintiiry wtU hAT«* |wniit«ki .n t«t «lr%rl**t' A*««»nlinir !«• tin tN^^U. tlit< titW '<Hhrr 
•fi^WmiK- «UiiiMi« In oifi«f«|tH-tw N 'riMiiy nr •-%«*n liiMiui ll«*r«rKi»%'inA.«ir thr 
IaLaixI "f Hawaii ran tAk** < ••ntic . f tht* 'Iiwa^ 

M N'HVr t FnuM^r wikf^l thAt a |4*- !*• tfl%rn IrimMV fi»ll<»wtnir ci«it«Hrt<XM 

tliiw^iw^ with whit h It tirrwntH IIUUIT AI&JkI<<V'« 

Tlir ivi^rw-nlAtiirw .tf Km^tA atvl IW*iinatu • ip rn ^wil a fltmiUr «>|ilnl««i. 

Thr |ir*)«ailtl«<l t»f IIm* «|rl«*|niU* of thr I'titteil **tAtra U »|ii|»tnl. 

••lC>f4^t* M<«r i«l> ••!' Till HI %ltT 

I>r « n^T L Willmr < Mw hi«mn An«t« that thu titl- U*'k« pr^riiiinn. ninl thinks 
tiMt iiuUiT ilrathtt Afv vVm\m I iiHilrr tt whw h Af«' r^mllir l«*l iliJMm<Mni 

||r a1m» •tAir« thAl thrr«* \% »•» rtpr«'«iiV*n in Fr%'t»i h t«»tnuiAlAli* thr tmn hf«rt 
lAiltin* ' whii h i« tlir •\m^ iaI "i^pr •(•Tintii 'if Amrn4*An n»<*rtAht> MAiMii* 

Hr pr <!■«»« t*>< Ua* tir«rt fAittm- Aiii><fiic ill •lrttnr»1 ftt*rAJv« 

/»%» iMfM M NfM«-r Krvfi'V r<iiiArkn| thAt tli«- ol*)*^ ti*(nAt*l« ripn^tniin 
U f"*!?**! in «4hrf fxnit* in <iChrr •••nntrw** In <*rrfnAn)r tl»«' tipri-wt^-n* " hfTi- 
lAJiitinw imfUrnf ••f tha- hrart ' brrvflK'hlnic A|H>|itc*i%- «*f tl»r hnArt liA%r ti«» 

lU'-rr Aliriallii-Atli^l 

I Hhrr» ruifii — I tlw- «AiBr ••|iittfti4i AOil thr MAmrw Afv* thm»fi*ffv takrn «Htt «iC 
I hi* l»«wilinir 

•TMIA %itt>TI<t%* 'tr THR « tm t I ir«*ll\ «%«TK1I. 

I:.- «iM|r llt»*lrr thM ha^H^llniC « ATllAi Aii t*lmt* t»-4 ilrtrmilttnl • . «|dmki* tmn>ir. 
•|4«-t»i*|«»lh% rli 

llr* 



M ltr*>aAr«lrl Krnnrtr. ftmU it l»l t«i (•mnt Uk* «I i ^ai m «»f thr •|4««« nn«lrr 

thi* ha^nvtlni; It W«i«i«l \w U * * %mm ^ t\ rtth>r ttttifB'n A Al*^ IaI lir«ilin|C ((f la^Cfl^. 
t«> .«mftl«|rr thrtn llAilrr thr |M«tllti|C iMlQtllAl « At hvtUi f**r thr> Afr Almtwl 

AiwA«B tif itudATwU ••ft^n 

M iCMTitAtt I'nlU^I hUUfW Ab*U IImI Ihu «4ullt«t w..iil«l lui«r It* im^itiTrfi 
Vmmwm f*tff •|4rt»fc« tllmM^ In Al»rn«A Afv |><4 aIwa«« of IliAlAflAi iiClirlO. AImI 
|i««-f rTB A mUr*. IaI h«*tlintf 

^M\\\» c^t.»IIJT\ 

l>r «*r*«»%L WiltMirntitU thr «i ••?«!■ frnilr •|rU)ii> n|ni« Ah-nt t<» An aImtimv 

*A •liA«n»'»l« *ImI |>ff«>|«Mr« t«> t Um tlilA lir^tiniC Un«trt til «|rni»r«| «Uii aw ■ 

In ihr 'llai iM«*.«i <4t thu titlrwtliiiti Att Altrtu|fl WA* liiAtIr !.• fit tin Aifr Aftrf 

«ihW li •trUllIt |UA« t«>i«ltr«i H-tollr 

M |lf«i«iAr«lrl <l*fAl»«- lh^*«ltfht IIiaI thu «iHll»l !•- %*t\ •lirti« iltt tf «l>* 
TW • lAuiulMAiAa WA* ••! If»r wmMUr ••{rtak«iti ait*! tlv ItrAitinif « a* inAllilAll»r«l 

«%TIIA« t 

An An^rWAn ffhfAli lAto «ikr«| thAt «-ArlAftiM h* «ln« !•• •lA|th)l««^«« lu l«* imiC 

C««lf«lH«l with ' MuAllinuUlt |MMllllr ttf AnlhrAt tllftr t.. I«»i ||lll« Allthriit u 



38 MARINE-HOSPITAL SERVICE. 

t 

Remarks. — Malignant pustule is a general disease, due to baciUns anthn 
(charbon), and is inchided under heading No. 16. 

Furoncle, due to staphylococcus, is included under heading No. 127. 

The word anthrax is not a synonym for malignant pustule m French — ai 
the case in English. 

M. Bertillon (France) believes that the word *' anthrax" leads to confnsi 
for in several countries it is synonymous with '' charbon," '* malignant pnstol 
He suggests, therefore, that it be replaced by '* furoncle." 

(Adopted. ) 

INFANTILE DIARRHEA. 

Dr. Cressy L. Wilbur (Michigan) and several other American physicians ai^ 
that an age limit (2 or 5 years) be fixed. The customs followed in the differ 
bureaus of statistics are very variable in this regard. 

The commission fixed the age limit at two years. 

PROGREaSIVE MUSCULAR ATROPHY. 

An American physician proposed to omit this heading and to add it to '* ot 
diseases of the nervous system," because of the rarity of the disease. 
This was done. 

CONGESTION AND CEREBRAL HEMORRHAGE. 

Dr. Cressy L. Wilbur and several others prefer the word ** apoplexy,*' and 
"congestion." 
The commission decided to retain the text. 

OTHER FORMS OF INSANITY. 

An American physician asked that it be understood that when an insane per 
dies of another disease his death be recorded to that disease and not to his mei 
state. 

The commission confirmed this opinion. 

DYSENTERY. 

*' Dysentery is placed among the general diseases instead of under disease* 
the digestive system. This was in accordance with the suggestion of Aineri< 
registrars." 

ERYSIPELAS. 

'' Erysipelas is placed among the general diseases instead of under skin diseai 
This will meet the wishes of a large number of American statisticians who c 
sider the position of erysipelas as a serious objection to the old system. 1 
change was made at the retiuest of several American physicians, as well as other 

TUMORS. 

"Tumors are now placed in connection with cancers, but separately stat 
This desirable plan was first introduced, so far as we are aware, in the mortal 
statistics of the United States census, and the idea was adopted in the classifi 
tion formerly used in the Michigan registration reports before the adoption 
the Bertillon system. While the return is to some degree indefinite, a lai 
number of such cases are actually cancers, and it is useful to have the data 
close connection. Of course certain classes of tumors, as ovarian tnmors a 
fibroids, are elsewhere classified." (Michigan Monthly Bulletin of Vital S 
tistics, October. 1900.) 

The iyitenidtioiidl cUiHsification of diseases and eanses of death (Bertillon clot 
fication) OHndoptedbij an international ayin mission , and reportedto andadopi 
by the Eighth International Congress of Hygiene and Demography, JF\it 
Franee, August IS to •::s, luoo. 



The need for a uniform comparable system of nomenclature of uiseases a 
causes of death has long been felt by .sanitarians and statisticians, and efforts hf 
not been wanting to liring one about, but the difficulties in the way of such 
international agreement liave heretofore seemed insurmountable. 

The International Institute of Statistics at the Vienna meeting in 1891 vol 
(upon motion of Dr. Guillaume, director of statistics of the Republic of Switl 



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40 MARINE-HOSPITAL 8EEVICE. 

I. General diseases — Continned. 

10. Influenza. 

11. Miliary fever (sweating fever). 

12. Asiatic cholera. 

13. Cholera nostras. 

14. Dysentery. 

14. Repeated. Of which, epidemic dysentery. 

15. Bubonic plague. 

16. Yellow fever. 

17. Leprosy. 

18. Erysipelas. 

19. Other epidemic diseases. 

20. Pyemia and septicemia. 

21. Glanders and farcy. 

22. Anthrax (malignant pustule). 

23. Rabies. 

24. Actinomycosis, trichinosis, etc 

25. Pellagra. 

26. Tuberculosis of the larynx. 

27. Tuberculosis of the lungs. 

28. Tuberculosis of the meninges. 

29. Abdominal tuberculosis. 

30. Pott's disease. 
81. Cold abscess. 

32. White swelling. 

33. Tuberculosis of other organs. 

34. General tuberculosis. 

35. Scrofula. 

36. Syphilis— 

A. Primary. 

B. Secondary. 

C. Tertiary. 

D. Hereditary. 

36. Rex)eated. Soft chancre. 

37. Gtonorrhea (adults). 

38. Gonococcal affections of infants. 



89. 
40. 
41. 
42. 
43. 
44. 
45. 



Cancer and other malignant 
tumors 



of the buccal cavity. 

of the stomach, liver. 

of the peritoneum, intestines, reotiim 

of the female genital organs. 

of the breast. 

of the skin. 

of other organs, and unsi)ecified. 



46. Other tumors (except of the female genital organs). 

47. Acute articular rheumatism. 

48. Chronic rheumatism and gout. 

49. Scurvy. 

50. Diabetes. 

51. Exophthalmic goiter. 

52. Addison's disease. 

53. Leukemia. 

54. Anemia, chlorosis. 

55. Other general diseases. 

56. Alcoholism, acute and chronic. 

57. (Tronic lead poisoning. 

58. Other chronic poisonings of occupations. 

59. Other chronic poisonings. 

II. Diseases of the nervous system and of the organs of special sense: 

60. Encephalitis. 

61. Simple meningitis. 

61. Repeated. Of which, epidemic cerebrospinal meningitis. 

62. Progressive locomotor ataxia. 

6; J. Other diseases of the spinal cord. 

64. Cerebral congestion and hemorrhage. 

(J5. Cerebral softening. 

66. Paralysis, cause unsxiecified. 

67. Paretic dementia. 

68. Other forms of insanity. 

69. Epilepsy. 



MAUitRnaiirrrAL nnTint. 41 

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34 MARINE-HOSPITAL SERVICE. 

They cultivated the organism on potato bathed in 6 per cent watery glycerin 
8< )lution. Some colonies take the fatty , bnlbons appearances. By cnltivatdng these 
colonies they finally arrive<l at an organism having the characters of the tubercle 
bacillus of birds. The young bacilli of these cultures decolorized very readily with 
aiids. As to virulence, this also was modified. The organism no longer gave the 
villemin type, but the yersin type, and became very virulent for chickenB. 



Report on the PRocEEDiNcis of the Commission Charged with the Revi- 
sion OF THE Nomenclature of Causfj; of Death at Paris, France, August 
18-21, 1900. 

(Bertillon classification.) 
By P. A. SurK. M. J. Rohknau, Vico-President of tho Commiflrfon. 

Paris, France, Noi^^mher JO, lOOCt, 

Sir: I have the honor to submit herewith my report upon the work of the 
commission charged to revise the nomenclature of the causes of death. 

This nomenclature has been recommended for general adoption on January 1, 
MM) I, by the International Congress of Hygiene and Demography, by tho Inter- 
national Statistical Institute, by the American Public Health Association, and by 
the International Conference of State and Provincial Boards of Health. 

This international revision, which was largely brought about by American 
registrars, has already been adopted by the following cities and States: Maine, 
New Hampshire, Vermont, Massachusetts. Rhode Island, Connecticut, New Jer- 
sey. Pennsylvania, Delaware. Maryland, Distric't of Columbia, Michigan, Indiana, 
Minnesotii, Colorado, etc., Greater New York, Boston, Buffalo, Baltimore, Savan- 
nah, Columbus, Milwaukee, Dubuque, Toledo, Washington, Charlestown, etc. 

It is important that all these States and cities use a similar translation. I am 
infonned that some of them are waiting for my official translation, and I have 
therefore to respectfully request that the report be printed as soon as practicable, 
in order that it may be ready for use for the statistics of 1901. 

I have also to respectfully recommend that our Service adopt the nomencla- 
tures in place of the anti(j[uated one now in use. 

Very respectfully, M. J. Rosen au. 

Passed AsKi'stmit Siirgemi, M, H. S. 

Surgeon-General, Marine-Hospital Service. 



[T^ttor of transinittal.] 

Paris, France, Novernl>er i, 1900. 

Sir: In compliance with your orders of July 10, I have tho honor to state that 
I attended the meetings of the International Congress charged to revise the 
nomenclature of the causes of death as the official delegate from the United States. 

The commission met August 18-21, 1900, with representatives from twentynsdx 
countries present. The work of the commission consisted largely in revising tlie 
old system of nomenclature devised by Dr. Jacques Bertillon, chief of the borean 
of municipal statistics of the city of Paris. Although many changes were made 
in this old svstem to meet tlie march of progress, nevertheless the nomenclatnxv 
as adopted )yy the commission is (essentially the Bertillon system, and the credit 
and honor is due Dr. Bertillon, not only as being the father of the nomenclatnie, 
but for the great industry and zeal shown by him in bringing about international 
uniformitv. 

To American registrars, in particular Dr. Cressy L. Wilbur, chief of the divisi(ni 
of vital statistics of the State of Michigan, belongs the credit of being most active 
in bringing aboTit this revision, and in suggesting important improvements. 

Inclosed is an extract from the pn)ceedings. which shows the part taken by our 
country'. These ft'W ]>ages from the proceedings also indicate some of the dimcQl- 
ties that confronted the commission composed of members from so many parts of 
the world, speaking so many different languages. 

TIk' work of the connnission. as given in the finished nomenclatures, is by no 
nwans perfe<-t. Then^ are two reasons for this: 

First. TIk^ cljissification is based on the seat of the disease and not its cause. 
Mt'dicine is not yet a sufficiently exact science to gather mortality statistioi 
according to the cause of the disease. 

Second. The nomenclature is a compromise. This is a necessity where so many 



MAIUIIKHiminTAL HICK%*irR« 48 

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8« MAKIXK-Hir^PITAL <ERVI.E. 

/'"/-//. J/r, T*-^A$6ihVt (^ain-in*,: Dr. PaM-:. .S. Minr^rU*. ai-f of the medical di*- 
Ittft^iiry H* th'- r'niv«-r--ity of Lima: Err. y-nLAn-: I»t. Aiit«'izL>^ P^rvz Roi-a pro- 
tt'*i^fr At. ih*' \'uivfir':^ity of Lima: Dr. Arrrar'l V-l-z. -ieon of the Faculty^ 
M'-'Unit^. of Lir/ia. 

f**n'iiiifal.~-\n. fVrreira 'le Matt^^xi. jr.. pr -f-^tssr a: thr CniTeraitv of OxmbR: 
\pt. J"jiri *\f M*rIIo Viarma. member of the H<jyal Ar«kl»rm.y -jf ^Hences at Ldsbon: 

/fitMni/i.- -J}r. i^aMile Gr*r>^nrhu-hikoif. opnii'^il' r -.f state and aisent of statts- 
fl'al anrj tfjtifhfmvtlfffO^itl affair^ in the ii-ijartiurnt -f m<?dioizie: l>r. Alezandn 
'I iinofHew. rhief of bureau in the «lejjartm»-nt ■•? m«*ti:«.iiit. 

lit'f/ultlh' iff SalrwUir, — Mr. Rafael 2^<livar. miziistc-r plenipotentiary of Sad- 
\'iu\ur in Parin. 

/</rr///'7i.— f>r. Wawrin.Hky. r-ouncilor tu th»^ r»yal me«iiL>al administration of 

Hwiiz*'rUintl,~\n, Gnillanme. dirH*.t«ir --f th*:* fe^ieral barman of stsitistics it 
li«jrfie. 

fhifiuif/. \yr. Alfnj<l Navarro: Dr. Hnnri Pouey. pn^fes^^r at the Facnlty of 
M<-«lif:hjo of Mont'rvide'/. 

KXTItACTS KICOM THE PK'^K'KKDINiiS . iF THE COJOnSWIOX. 

Thu pnKMMMliiiKH in which the United States took a special part is herewith 
n'pnMlurwl. While there waH only one official delegate from theXJnited Statce 
prcMont at the ineetinKH of the couimission. nevertheless its work received con- 
Hiderablft Htt«;ntion from American registrars, who commonicated their opinion is 
writing- Th(M«» HUKK^^'Stirin.s receiveil the careftd consideration of the commtSBioo. 

TUBKR<;UIX>SIS. 

M J{<'rti1hiTi (France) siKike against classing all tnbercnlous diseaaee together. 
bill iirefcrnNi Ut pl»<'e them under the hea<ling for each organ. This arrangement 
would enable one without difficulty to know the total number of cases of menin- 
gltis. for ('xatri|)hf. which is very us«;ful, for among so-<*alled "simple meningitis" 
thiTo are without doubt many that are tuberculous. The same obseryation 
Hpi»lii'H U} iHTitiinitis. ♦futf'ritis. etc. 

l)r. M. .1. KoHcnan (United States).— The prime importance of tnbercnloai 
iiiiikcH it in<liH|N>nH<i})le that w(t may l>e able to read from a statistical table with- 
out difllcnlty and without collecrting and a<lding up widely separated fi^oxea, tlK 
UAAi\ ntinilN'r of }mthouh dc^ml of tuln^rculosis. It seems inadvisable, then, to sep- 
ariit^f tulN'rculoHiH iimler m\a'\\ r)rgan a d thus divide the facts in many plaoee, M 
In done in the iiom<'nclatun) of V'irchow. Mr. Rosenau, therefore, "wbs opposed 
to till' prcijMwition of M. lJ«Ttillon. 

Af(«*r ftirthiT diH<'UHHion the c;ommis8ion decided by a vote of 12 to 8 (3 absent) 
that tulN'nMilitr diseiiM<>H should all bo grouped together in the same place. 

CIIOLKUA ASIATICA. 

Incluiln luidiT Ihis lit ruling. Indian choleni. cholera (without classification), 
choliM'u uiorbuH. and <*pifleiuic cholcm. 

(Vio/r-rrr iHtstrns, Dr. M. A. lif>H4'nau explaine<l to the commission what tbe 
wuiitiiry council of the Provinc«' of QuelM»<; and other American physicianB had 
pii*viouHly HuggcHlcd. vi/., that in America "cholera morbus*' does not mean 
" Asiiilic cholrni." 

M. hroujinlcl (Kniu<M') thinks tliat the expression cholera morbus, formc^r 
uhimI to Minnify cholera iisi:iti<'ii. 1ms become infretpient. He thinks therefore thHt 
the womIh " « holeni niorhus " may be omitted from the amplification of the heading 
{ 'ho era ii»*jat uji. This w<»iil<l permit each coimtry to interpret this expression in 
col. fortuity with current iisiige. 

(A«lopteiI.> 

InchiibMiuiler this ]ieM<ling varit>la. varioloid. D«) not include varicella. Tn- 
ipti«ut couiplieatiiMis. uieuiugitis. eu(t<N'arditis. suppuration, albuminuria. 

An Aineiieau ph\si» iau suuirestetl that "varicella" 1m' ])lace(l under the heading 
" \ jiviola; " ileatliM iroiu \arirella can be eounted witlntut error as due to yaiioU. 

Ml Knvi»s\ t»\pi'«»'.s«M| au aiialogiMis o]iiui«)u. Varicella, he said, never 
diMiih bu! when then' is a death, it is n^ally varii>la. and the record ahonld 
uti» ib^ath to ihiH diseasiv 

Thi» HtatiMical de|Mrtuieut «»t' the city of Vienna was of the 88 



1IARI!«IC-HfMriTAL HKKVirK. 217 



m —Mr V^nnlmtft^r <fMrmAti)rt m\mik^ a«Aiiifll thr i»pinina mi 
hy Mr i|«* K*iri«y liAfft* mm <tf«lh« fn-iii tArv^IU «rv. tbry Art* wtmHliiM mH 
with THrjr luiir«> ci<ifll«lmit4«* ttn|B*nAi>i^ in rouiitHrs •ttrh an flfmuMir. whlrh 
Mt» w«»ll |m4M-tr«l Aomlnirt vartnU. Un it hm^iui tum-b t4» kinfW wbMbi^ iVwttn 
( wbHbrr <«■» «ir lw«>) anf> fn«a rmriiiU «ir ▼atii'vUa. 

Mr Wortlisnipr |ir«i|KMnl tu rHalti thr t**it. 

(Tpxt BMUataiftf<d. > 

iingn^ --IH. M J R««ifiM (rnitml HUtM» wtrnM Hk«* tn ««• M|r In tli«* flf«l 
« UiwtfW«lli4i Till* «liM«ffp tiTMviitJi m |airtitiiUr intmwt fn<it thr |M4tit <»f virw 
of ititfl-rryiti'iiuU hytfWtif . «ti«| tn <inlrr !■» kiv^* «I<i«* wAminjc that a |»irt (tr ovnntnr 
!• mrtuM^I thr Winilily |fcitill< Atliic»« •h<m|il |Hil»li«h f%rrT rmm mm »•« •* It U 

M llrrctli«« I Frmni^' tinii*«vitt u* )«mrr t*i r^i-h omntrT tntrn^tnl thr |imni» 
■I* 41 to imt thi« hv^Mltnic tn thr flrat < Uiwtm-ati«4i «* writ «!• tn itn wni'lih rr|»ift* 
iSii U» m ««4r. thr |ir«*|»Miti«4i <»f M lii«r^Mtt wjMi l««»t r* \ <»!•<« aicntn«t ^t 
i^l»rt^9 I>r M J liia«*tiiiti I'ntt*^! Stjit««i. l^\»r^my i* %rry nir«» in thr 
f *nttr<| Slai««i Thrrr mrrr vrr y frw tlcmth* f nun thU itiwnMr rmh yrmr. Iliiwrvrr. 
tn «irw iif it« lni|B<rtAO«Y thr sfamki-r I* in fnrnr of luakinK m •{■^k-uJ hff««linit ftir 



•U-i. 



Iik*<i|i»r« Ilmtl)«ia 'Vrmtw-*- ihtnk* that tht« t> n*4 r^ry n«»fnl. mm mm'h 
rtmntry wilt h*rr tvrtnt<«a 'n t«» «lr«f|«t|». a«^-oriltnir V* it» tim|«. thr titlr "Othrr 
m%mAtfau- *M i m ■ In o»n«iW|firf>i^ S^rmmy «*r t-^rn li«Miui llrrtrgortiiA.cir thr 
t»)hu»*l of llnWAit.rmn tAk«* <«»ntit • f thu •lt«^«M* 

M NHt« r •Krmnop- apkt^l tluit « |»Ui~** \m» KiYrn Irpniay f«ill4»wtnir t^tntimidiM 

cU«r«^ir<i. Wtth whltb It t»rr«i-ntll ttuUIT J»nAl<<1r« 

Thr f«-|«rw-ntAtt%ra **f Hwmim j»n<l llrlinniu > tp n^ ^w ■! j» fiimiUr otilnl««i. 

Thr |iri|»aBltli<l of thr ilrlripitr of thr Inttr*! HtAt«« I* »|ti|itr«l. 

•>Ki«4H|< t>t«i:\«l> ••!- Till Ml %HT 

fir ( n«»T L Wtllmr (Mwhi«mn ftn<l« thjit thu titl«* U* k« prr^Mm.ninl thinks 
tlwit iiiAny ilrsth* mrr i i ^ u m I iin«lrr tt whi* h »r«* r««l)y IvmI <liAicn«Mptt 

li«* »1mi •tatr« tliAt thrr«* u tf* ripr«'«iil**n in Fn»*tM h lotnuuUjitr thr trnn * hf«ft 
failtin*. " «hw h t« thr aiv* uk\ **yi»T^»^^r\nui »»f Anirru-mn n>i«rtalit\ •tAti«tl<^ ' 

llr }>r* •)■«»« to • Ua* t»r«r1 fjtlltm* •lll'*Cl|C iH «|r||nrtt t||«»-A«r« 

tHm 'tmmt.'H M Ntttrf Knir*< r r«-iiuirkr«| that th«- o|i).^ ttonjilil* «-inr»— tim 
hm f'int><l tn «4hrr fofl-ii>« tn «ilhrr i»««intrira In <*rmiAfiy th«* t-t|in<«p|**n* ' hm- 
Unt'ttti; tair«ly«u of th*- hr«rt - " brrm hUic a|a*tilriy of tlir Itf-mrt |yi«r m* 
t«><-r>* »iirntlii-*iki««i 

i Hhrrm rifir n — il tlir mmttkr ^liin^m nOil thr nnmm nfr thrnpfofv takrn •>tlt <iC 
till* l»r^ltnar 

•Tiitn %trf*Tit»%« .«r tnr « ia> i i.%r«*ii^ •%«r«ii. 
lii< imlr nn«lrf thM ha^nvliniC « Anil*' «ivi*lmi« n-< •lr««-nntnf<i| * siftlrnir tnimir. 
M flntuinlrl rrmarri ftmU tt l»l t*> ttinnt thr «lto-iM of thr »|4««« niwirr 

this iMHAiliniC it W«i«i«l lar n i l ! W f> rtthrr tttiifarn A •|H^-tnl htmtllmc or la^lfl»r. 
ti* ««rtk»»«l«r ihrtn lunlrr thr hm«ltnic |«Uq*IIjU «*hetu f>«f thr% mf Alnnait 
Al«i«%» of itudATiAl ••rt^n. 

U ICMrUAM ■ Cnttrtl h«Alr« An*U thAt thu Milntii^i W'.ii|«| KA«r ti« tm^mTrti 
l«tkiw f"f •|4rtti« <ltanMr« tn Ainrru* mtw n*4 Al«r«)« of isuU*nAl «irttfin Aa«l 

|i««-f rTB m •l<m-t*J h*i««tlntf 
At|o|4iM 

•»•:.« tl« i>tt»tljr% 
I If i *r*«»% L Wtllmr rtiMU thr i> *#?%!• »-nilr fWUlll> f«|iit% Ah-ni t»* mt% jilwrtH^ 

%j{ •IU|rn«ikla Alwl |ir«'|«Mr« U» t Um thl« hr*tin|( iimtrf 111 «|rntir<| «Uii •■ ■ 

Its thr ifltti UMi|*4i '^i thu «itlr»tlon *n Attrtu|4 mmm iit**lr !•• fit lltr «|f«> mtXrT 

«hhi h «Wl4lit« UUk% la- ««Ilr»l artttlr 

M ItrotMftlrl KrAiiir th-mtfht IhAl IhU w.^M !•- «. r% «liftl« nil i'> •!• 
Thr •««niMlairti4a w»a of |Im> «Ui»r tftilnWili altil tlw ^••'UKltiti; w *• lUAlii1*llBrB| 



«%fiin«t 



)m *lv^ to stAith^l**-*** ua l«* iMiC 
l*t lafti tlliia aiithnii U 



46 MARINE-HOSPITAL SERVICE. 

B. AKKIIMIKO NOMKN(*IiATIJiiE. 

Nambera cor- 
rospondinf tu 
thedetaifed 
namenclAtnre. 

1. Typhoid fever (ahdomanal typhns) _ . _ I 

2. Typhns fever 2 

3. Intermittent fever and malarial cachexia .. 4 

4. Bmidlpox - 5 

5. Measles - . 6 

6. Scarletfever __ 7 

7. Whoopinjf congh 8 

8. Diphtheria and cronp 9 

9. Innnenza 10 

10. Asiatic cholera 12 

11. Cholera nostras 18 

12. Other epidemic diseases 3, 11, 14, 15, 16, 18,11 

18. Tuberculosis of the lungs _ 27 

14. Tuberculosis of the meninges 28 

15. Other tuberculoses from 26 to S4 

16. Cancer and other malignant tumors.. from 39 to 45 

17. Simple meningitis. 61 

18. Congestion, hemorrhage, and softening of the brain 64 and 65 

19. Organic diseases of the heart _ _. 19 

20. Acute bronchitis 90 

21. Chronic bronchitis 91 

22. Pneumonia 91 

23. Diseases of the stomach (except cancer) 108 and IM 

24. Diarrhea and enteritis (under 2 years) _ lOS 

25. Hernia, intestinal obstruction _ _ _. 108 

26. Cirrhosis of the liver US 

27. Nephritis and Bright's disease — 119, 120 

28. Tumors (not cancers) and other diseases of the female genital 

organs from 127 to 132 

29. Puerperal septicemia (puerperal fever, peritonitis, phlebitis) 1J7 

30. Other accidents of the pueriH?riiiin. of pregnane v. and of labor 184, 

135, 136, 138, 189, 140, 1« 

31. Con&^enital debility and malformations 150, 151 

32. Senile debility 154 

33. Violent deaths from 155 to 171 

38 Violent deaths. Of which suicides from 156 to 161 

34. Other diseases 17,20,21,22,23,24,25,^5,36,87,38,46,47.48, 

49, 50, 51. 52, 53. 54, 55, 56, 57, 58, 59. 60. 62, 63, 66, 67, 68, 69, 70 71 72, 
73, 74, 75, 76, 77. 78, 81 , 82, 83, 84. 85. 86, 87. 88, 89. 92, 94, 95, 96, 97* «. 

99, 100,101.102,106,107,109,110,111,113,114,115,116,117,118 181. 
122, 123, 124, 125. 126, 133, 142, 143, 144, 145, 146, 147, 148, 149, 168,151 

35. Diseases not known or ill defined from 177 to' 189 

III. NOMENCLATURK OF THK CAUSES OF INTRA-UTERINE DEATH. 

I. Diseases of the mother: 

Syphilis. 

Other general diseases. 

Predisposition to abort. 

Albuminuria and other diseases i>eciiliar t<) pn*Kiiant'y. 

Traumatism and excessive work. 
II. Diseases of the placenta and its enveloi>es (chorion, etc.). 
III. Disc»aseas of the fetus: 

Malformations (hydrocephalus, etc.). 

Premature births, etc. 
TV. Accidents of labor: 

Malformations of the mother, etc. 

Bail presentation of th(» infant, pt<3. 

Displacement and (•()iui)ression of t]i»» cord, etc. 

Asi>hyxia. 
V. Divers and not c^lassifie<l. 
VI. Causes not specified or unknown. 



IIAR13«R«n««nTAL HKRVirK. 47 

r\v\ \s \rh*H tjr Tiir. Tin.rj* «••• tiik i€**ur,x* i.KXX'ur. **r tii*«r.Ai«RH 

0# •A>HvtR«/ tht •y»i«tt«y«it« tiNil 'liftrviAr* tuiimtifi MM«lrr nfr-i^ lifl« trttk r* fewyrmt^B 

«••.«•.««! l*lB84a«« 

r. Tfi»k*'*'l f'f^r -THu tttlr itw lti«W« Iii4hti»niU»ntiii. tntin«Mi. i^«iUtii»««il. 

Irrv Attatt< «>r AiUtuutiii- f* rrr. «U|>iiiiitijil tt|ihu* 

n«t> titli- •! «^ »)••< tti* hii|« A<l>tuuiita I rii> . Atati* •ilytiAiiiui - ITHi 

rr«^{*>« tit I*-!!!!!}!' atixri* I'D* Mill' 41 ui. |Hi)iiti*fiarT <-**ttirf*«>ti*«fi. tiit««atitMU |wTf«irm- 

«i. tvnN'ritii« nit««iitiAl Ih ts»*«rr)uiir«*, •louKlithif lillMitiittinrui. 

:. /y|*/tii« T)i:« lit if Itn hvlto* I'* t«^ htttj ff%tr, |a-tff^ hlal t>|4iitJi. 

rbu titl*- «!«• « tt 't tn« Itflc AUloiiiituil t%|»liitA > 1 

lCKil»k% Tti«* « nl t%t'h<^* «»iih'«tit i|tuK)th' Ati^n m\l\ U* tAkt-n In th^ wiiar 

it tt i« • r^ttr^Dlr uti«l« r»i<»*« It. t-mU «i>ut>tr% r«ir rtjuu|4«* in lli«* •rtiar' «»f 

J«|'t(iiitiAl t%|>Ktia iti th«* ( ff« niijUl Ulltr^UMTr Al»il Itl ti«r m-nmr **t rtAlltb«*tUatil* 
[4)ii« 1-. \U»* l*r«t«« U !.*ti^t|jiir< m1«» In KMi;lt«li 

t;. i4tf**'u,j f^'wT Ttiim u\U* in* UhtU m ll«^ nrrk-nt t«t*liti« 

» /..'./ It. iff. ..f '.•• r .tf.f f •i/'irt't/ •>!''../ i«i TtiU?lt«« till lniU-w f "AlOil^l frTvr. 

mt< t *«i* frttr m^^-mt |»rnitv«M r«tnt!t*nt f«'%«r. iiMlarui |iAlti«lU < sft'hftxUi. 

lt>ih«tli !■ f til I :• > M )it-lM. |«Aln«LAl Jltl'-tlltt 

tin* < »f m 1.1. )i itu»Ur:Aj « tf )i«tiA 

Hit* t:!l' 'l*^ i» X tif lti*U VAn««>!U :^ 

rr«^in«tit • ■ iii}ih- j»t»«ic»* \f«-ntnipti*. ri».l<« «nhii« •fi|*|«QrmlW«i. Allaitis«tnoHa. 
, l/r !•.■.» 1K:« t»Mf tf>« Iifilr^ M*a«J> • r fiU«».lir «rn|4l**n. 

i r«","i I.' ji;;-!:'-.!^ •»;• ltn»fii K M« > r>'i»* h«»> {<n>*nm<4iui. rU'. 

> -f ' '•' Ihi«t*:. '.n< i; !••* I'-.' r;- r^l •• 4rUt:nji » 4rUttn*l Aniptui 

I'rti,*!* ft* I . luj.h« •tt*'f;* .\n»Ml:. I.';*:* « > f . « iiUi> 'ti* t<«lt-tlUi ''f th^ tsk«4tl». 
ii>itrrt.JNr* • n*ii« «r«titi* |«-n« An!i*:* t«in»l««t« «ti|)tt)M rui. ti tamtwiA 

• II k.m,j»t> 7 <••••«. ;^ l*r«^l*i« f.t i»»iiii u Jill -ti* ltr«4ii hiti* i •*n%nUi«*«i* 

• iH^Jtt' . t ii.! I ir...i|. Tl;t« !:•.•• in< hi.l«« Ih|i|ith«'ntl)'. |H»'iiil«i»mirtiil4m 
c»* ir.f<» t «!• it.^ltin^tii iri' I A*.«*!nA* •tij-KtliirnAtn aI) f><ntui.«t««lr«|wi iaIU 
^lU.rr.A'f « M».-l« if th*- •k?». * fK* • >'ti;tirM ti« A. tn titr. «•!. . |««^ii|4» tlirtu- 
»t» -.• tr '^ *. *i* ;•» til > nirii.tr*- .* '.^r ^i i.^'lt:*. ntj^.inkAnt lAf^niCl'U. «ll|»h' 
rritl> |«krAl«a'.« 

Hit* T.'It Iv* tf^'. ttk- t't'l' *«trvliil 'itt • r>*«i|« **«^ •|i*«iSiMtii|it « i>i«i|i **^ . f •!■• 

Krt^t'i* nt < *^m|»ti« Af^in* l*T>'mift'<cit« AllmintnnnA |«r»l««i« 
^•.t 4>f«hi«K •h|-hthr>riA 

/. <<.«•• I Thi* till lt»lUfi|*« l«ri|t|ail iMtfrnnf^iui <«r imr-moa^ilA <lii«> !•» 

HlVrutJk lif 4** hllU i<r ltnt»i h*» (tkrUtU- flLa «|f|r |«* ItillllcltAA 
V>/ii' f '' •* r riil« tltU* tty ll»|r« ^|«^|r 

If. .'.f>i .t«».tfi •! T!a« titlr- im lu>l«^ IbiliAtt • l^i|«-r« • Ki4rrm •wifbiHit 
u»I:f. All li «tt'l«ttib • h 4>rrm 

« ' . > . tf- •• Mil* iitW itM Iuil#^ **l«*fi»ili« • lii»tvfi» . Ii«»l«^nr, riMiWn 

rtll iLArrt^rtti rt.*«rti.* r^« 

1 1, n f)'*. i «r« t« ! itj ^I'lr 1 1*' I* r» ttifAtitiiiii *.*»'• 4n!iitfti4kiA4 « li'tU-m 'ir% 
rti--». . L If f • '••■ 

K'Htiiik I f.« «i r*la ' U Irffa It. rli«&« «ill !■* tddlit n m ib«- nrnM* iHaI tt i«*if«li 
J.'.* til. Ir f»* ••!'.« ^ h • <*«iftir^ f -r r t«isttU«- in tike •«-fiw tf « l>-4r-r« iKwIriMi In 
( t !.if«*t *«(4*i« f An*rrt«* «irl 'b tl«r «^fcM- t.f AaUktw thiamin l*nui*«* af»i| 

f.' f ' • iit.tfw^ 

.11.^ r • ''.« r If {!*]•< fititrv<* 

^ ■• « 'f wl.k K c^it'lciuli «ltMPtitrrii 
/ > / Il.:» IMlr lit. ItMlrw |^P•|r 

I ti •- ^f • « r Tbi« tlll«* Itft'lttWw HLm k «>4Utl « >fnll*' lwrt(f«* tr\fr 

/■I* '•« Tilt* fltW Ifk- lt» |r* I.W*|*luintlMt» ••' llkiT l«ffr«-^a 

ll.is t!ti< '1 V • it*tt it>< I'liW- I.W I luMif i*»i« »rM*'Utit i • ' «r*t'l»Ant*«al» 'if lb«* 
r«*«» : 4 '11 %1'ifft all • «llvi««r <>1 •) nnir**tii%« l.tu •• 

Ary».|»/.i* Iiii» iiiU Ito lt*i|r« AUtr>«i|«LM «ilM-flM r ii«r»lk *!••? •urifiiiU. 

^1 m \^%t %rr ||« aUu«t*i«i 



4-r MARINE-HOSPITAL SERVICE. 

Til- -irJrr ^j-^n^ not int-lud^*: GaiiKrenouH or phleginonons erysipelas (144), errsp 
-jw. .»!.* -c.>CTi'>n 144;. 

■rr^f *jfi/if'ti,ir tfixt'tisrs. — ThiH title includes: Mnuipn, rubeola, G«nna 
ni-swAt-^ v.T Aynisk, r-hi'-ke:i i>ox (beriberi). an<l every other epidemic disease nd 
•f>r::tf*< :z. tbfr nomenclature. 

Ti---* r-*.>'i''^« not include: Epidemic dysentery (14bis), epidemic cerebmspini 

idfx *itx.— .Should one of these epidemic diseases break out, it will then be necef 
V. 'rr^fikXfz h*fre a provisional s]»ecial title for it. 



r, /'y Tft /// nml mptivem ia. — This title includes: Purulent infections, abeorptioi 
:f ;r;r^.*T*t matter, putrid infection, alworption of putrid matter, putrid ferer. 




reported as havins 

-ry.-:rT*d fr'/tn septicemia, the certificate should be returned to the physician fcr 
»K*V?rr.ietit wlj<-th*'r the wj^ticemia was or was not puerperal. 

:'. ^}Utnih:rn nnfl furry. 

i':, Anih raj:.— Thin title includes: Malignant jmstule. charbon. 

>;. /i/ji>/*Vjr.— Til is title includes: Hydrophobia. 

Tr^ifi titUr d'ies not incdude: Sitioi)hobia (68). 

r^. A^tino/tit/f'OMiM. trichinosis, etc. — This title includes: Dystoiua hepatknm. 



'.-r'Tv^T^nu. 



T>/;.- titl<; <\fffiH not include: Cysts or hydatic tumors of the liver (111), or of the 
:*3r*;f» f'Jih. int<;Htinal parasites (107). 
.'', I'*Un(fra. 

:*,. Ttiff^-rruloftis of the. laripid'. — This title includes: Tubercular lar3mgit& 
lakryiif^hhl phthisis. 

.,'/. TnlMTcnltmiH of the hnujs, — This title includes: Pulmonary tubeicolm 
pnlmonarv phthisis (without qualification), phyinatosis, tubercle of the Inngi 
a/.'Ut^, galloping, miliary tul)erculo8is or phthisis; granulations of the \iXDp 
'grannlie;; imlmonary cavities: consumi tion; caseous pneumonia; tubercnlar. 
Irfi/rillary. specific, granular, neoplastic or heteroplastic bronchitis or pneumank 
tnljerrmlar pleurisy; tubercular hcmoptisis, tul)erculo8is (without qtialification. 

This title dfxis not include: Hemoptisis (without qualification) (09) , pulmonirj 
hemorrhage (99) .bronchorragia (without qualification) (99) , pneumonie du somiaet 
^apical pneumonia) (93), laryngeal phthisis (26), pulmonary anthracosia (99). 

Frwiuent comidications: Hemorrhage, pneumonia, pleurisy, X)er8istent diairb* 

Remark. — See observation made under No. 9;}, relative to **pneuxnom6 di 
sTimmet" (apical pneumonia). 

^H. TuljercHlosis of the nieniiif/eH. — This title includes: Tubercular zneningitk 
meningeal tuberculosis, granular, miliary, caseous, l7acillar>', specific, neoplastic 
heteroplastic meningitis. 

This title does not include: Meningitis (without (iualific-ation) even for infimti 
(61). 

20. AMominrtl tubercKlosis. — This title in(;ludes: Tul)ercular, granular, bad^ 
lary, specific, peritonitis; peritoneal tul)erculosiK; tuliercular enteritis. 

So. Pott's disease. — This title includes: Caries of the vertebra (mal vert^bniy 
spine disease, jwlyarthritis vertebral. 

Frequent complications: Cold abscess, j aniplegia. 

.77. Cold abscess, — This title includes: Ossifluent abscess, 

SJ. White sicellimj, — This title includes: Articular fungosity, coxalna wrp 
ulalgia. ' 

.A/. Tuberculosis of oilier onjous. —This title includes: Tuberculosis of the Am 
lupus, tubercular nei)hritis, bacillaryabsiM'ss, tubercular ulcer, tuberculosis of tiii 
bones. 

This title d<x*s not include: P()tt"s dis(»ase (JJO). 

.'/.;. Geuerol tuberculosis. — This title includes: TulM^rculosis indicated simulta 
neously in two or more organs. 

./.>. *SV7v>/f//f(.- -This title includes: Lyini)hatisni, scrofulide. 

This title does not include: S<;roful( »us or lynii)hatic blepharitis, <*on junctivitiB,a 
kei'atitis (75). * ' 

J';. Syphilis.— {o) Primarj', {b) s(vondary. (r) tertiar>', (^0 here<litary. The* 
divisions are only intended for the morbidity statistics. 

This title includes: (a) Indurated or hand Chancre, chancre of the mouth ord 
the face: {b) secondary— mucous ])laques, amygdalitis, or angina on larynflditii 
syphilitic; (r) tertiary— spH-ific syni])tonis, gumma, ulcenitions, exostostsTetG. 
syiMMiic. ost^Mxropic i>ains. Kv(»ry diw»ase with the (jualification ** syiihilitlc." 
2!liis title does not include soft chancre, simple or phagtnlenic chancre (SOhda). 



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50 MABINE-HOSPITAL SERVICE. 

This title doeft not inclnde: Organic^ diseases of rheumatic oriKin (79,etr,i. 
rheuiuatic iritis (75), rheumatic nodes (48), hlennorrhagic rhenitiatisiu (37). 

4S. Chronic rhcnmfifisin and (jout, — This title inctludes: Rheumatic nodes. 

yj. Svnrvf/. — This title includes: Werlhoff's disease. 

't'f. Diahi'trs. — This title includes: Glycosuria. 

Fr<3quent complications: Pneumonia, furuncles, j^angrene, hemorrha^ or aoft- 
ening of the brain, tuberculosis. 

61. Kvoph fhalni ic goiter. — This title includes: Exophthalmos, Basedow*B diKewe. 
Grave's disetise. exophthalmic cachexia. 

Fre<iuent complications: Hypertrophy of the heart, cjw^hexia. 

/iJ. Addi.snn's disca.sc. — Frequent complications: Cachexia, ascites. 

.T,>. I.,euh tnia. — This title includes: Adeno. leukemia, leucocythemia, HodgkiE'' 
disease, pseudoleukemia. 

Fre([uent (complications: Hemorrhage, ascit<»s, apoplexy, cachexia. 

't4. Anemia chhtrosi.s. — This title includes: Pernicious anemia. 

This title does not include: Cerebral anemia (74c)- 

5/j. Other general diaeases. — This title includes: Autointoxication, infection 
fever, virulent diseases (without other explanation), visceral steatosis, acroiu- 
galie, general amyloid or fatty degeneration. 

.•>';. Acute (tr chronic alcoholism. — This title includes: Drunkenness. ethylisL 
alcoholic intoxication, alcoholic delirium, al(u>holic insanity, delirinm tremens 
absinthism, dipsomania. 

This title does not include: Alcoholic cirrhosis (112), general alcoholic jMXtAy^ 
(67), atheroma (HI), nor any other organic affections attributed to alcoholism. 
amblyopia by intoxication (75). 

fj7. Chronic lead ])oi}i(fning. — This title includes: Lead colic, saturnine colic, 
painters' colic, saturnine encephalopathy, saturnine paralysis, saturnism, all dis- 
eiises qualified ** saturnine. ' ' 

.'7,v. Other chron ic pois<m ings of occupations. — This title includes; The mercurial 
(hydrargyrismus) intoxications, phosphorous, arsenical, or other chronic intoxica- 
tions when special menti(m is made by the physician, or in default of this infor- 
mation when the i)rofes8ion of the diseased indicates very clearly that the intoxi- 
cation is i)rofessional. In default of one of these two indications, compile ilx 
bulletin under heading No. 59. 

Phosphorous necrosis is always professional. 

'>!f. Other chronic i>ai.sonings. — (See observation ma<le underthe preceding pan- 
graph 5H). This title includes: Morj^hinism, cocainism, chronic ergotism. 

This title does not include: Amblyopia by intoxication (75). 

IT.- niSKASKS OF THK NKHVOCS SYSTK.M AM) THK OHOANS OF SBNSX. 

'io. Encephalitis. — This title includes: .Brain fever. 

o7. Simple menin(jitis. — This title includes: Meningitis (without qualificatioii). 
meningo-encei)halitis, i)arhymeningitis. ejndemic cerebrospinal meningitis. 

^7 /»/.s. — Of which, epidemic cerebrospinal meningitis. 

This title does not includt : Tubercular meningitis, and all its synonyms (3?). 
rheumatic meningitis (47). 

'/'J. Pntgressire locamotar ataxia. — This title includes: Duchenne's disease. 

';.?. Othrr diseases of the s})inal cord. — This title includes: Diseases of the cori. 
multijjle sclerosis, syTunictrical sc!lerr)sis, lat-eral sclerosis, sclerosis (without qnil* 
ificatioTi), Charcot's diseast*. Morvan's disease, syringomyelia, tal)e8 dorsalis spu- 
nuKlica, hemorrhage of the spinal cord, heniatomyelia. hematorrachis, myelitis. 
congestion of th(» m«-dnlla. alfections of the bulb, bulbar paralysis, spinal TMnaly* 
sis, panilysis agitans. shaking palsy, ascending ])aralysis. infantile paralysis, fatt; 

of tli(^ cord. Parkinson's disease. Friedreich's diaeut. 



or amyloid degeneration 

coni])ression of the medulla or of the cord, progressive muscular atrophv fiitty 
degeneration of the muscles, atrophic musc^ular paralysis, amyotrophia^ amjo* 
tro])hic ]>aralysis, atrophic i)anilysis, pseudo-hypertrophic paralysis. 

f!.}. Ct nftnif cniigr.sfinn and himarrhage. — This title includes: Ax>oplexy, cen- 
bral a])opl«'xy. meningeal apoi)lexy, serous apoplexy, cerebral atheroma. eoCTiuiof 
the brain, cerebral extravasation, hemorrhage of the cerebellum, meningeil 
hemorrhage. apoi)lecti(^ insanity. 

Frequent comi)licati<»ns: Heinii)le.G:ia, paralysis. 

'/.:. Ccnhntl sijffeninff. — This titl«' dfH*s not include: Senile dementia (154). 

Fre(inent complications: Hemiplegia, paralysis. i)ulmonay congestion. 

fH!. J*aralf/sis cause nnspf ei tied.— This title includes: Paralysis (without qiuili- 
fication). hemiplegia, facial paralysis, general paralysis (do not confuse witl 
j>aretic dementia). 



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52 MARINE-HOSPITAL 8ERVI0E. 

anre lap«o, Meniere's disease or vertigo, c^rieH of the jietroiis jwrtion of the tem- 
poral lx>ne, deafness, deaf-mutism. 
This title dfx?s not include: Mumps (19). 

III.— DIKKAHKH OK TIIK (M K<:irhATOItV KYMTKM. 

77. PprU*nrditiH. — This title includes: Cardi<)iieri(!arditis, hydropericardinm, 
liydropneumopericanlium, cardiac, a^lhesions. 

This title do<*s not include: Rheumatic pericarditis (47), endopericarditis (78), 
pleuropericarditis (IM), pneumoiH»ricarditis (1)8). 

7S. Acute emhH'avdiiis, — This title includes: Endocarditis (without <|iialifica- 
tion), acute mycK-arditis, or without (qualification, endoiwricarditis. 

This title does not include: Rheumatic endocarditis or other acute c^ardiac 
affections occurring during an attack of rheumatism (47). 

70, Organic fliHafscs of the hmrt. — This title includes: Aortic, mitral, tricuspid, 
cardiac or valyular affections or li'sions, insuffic-iency or stenosis, cardiac cachexia, 
hyx)ertrophy of the heart, dilatation of the heart^^ cardiectasis, steatosis of the 
heart, degeneration of the heart, cardiopathy, cardiac sclerosis, cardio vascular 
sclerosis, cardiomalacia, cardiostenosis, i)ersistent foramen ovale, tachycardia, 
rupture of the heart, (^ardiorrhexis, palpitations of the heart, asystole, cardiac 
asthma. 

This title does not include: Cardiac affections of undetermined character (86), 
I)ersistence of the foramen ovale (150). 

Fre<juent complications: Dropsy, bronchitis and pneumonia, albmnimiria, 
embolism, thrombosis. 

fy'O. Angina jyectoriH. — This title im^lndes: (.-ardialgia, stemalgia, neuralgia of 
the heart. 

81, Diseases of the arteries, atheroma, aneuHmn, etc. — This title includes: 
Arteritis, fatty degeneration of the arteries, arteriosclerosis, arterial atheroma, 
arteriectasis, aortic ec^tsisis, Hodgson's disease, stenosis of the pulmonary artery, 
aortitis, aneurismal tumor. 

This title does not include: Aortic valve diseases (79). 

S*, Embolism and th rombosis. — This title includes: Thrombosis (not puerperal), 
phlegmasia alba dolens (nonpueri)eral) , 

This title does not include: Puerjxiral em}K)li (140). 

S'f, Affections of the veins (variees, hemorrhoids, phlebitis, etc), — Thia title 
includes: pneumophlebitis, varicose ulcer, varicocele. 

This title does not include: Puerperal phlebitis (137), vascular or erectile 
tumor (46) , angioma (46). 

S4. Diseases of the lymphatic system {lymphangitis, etc), — This title includes: 
Angioleucitis, aclenoimthia. lymphangitis. 

'Diis title does not include: Suppurating adenitis (144). plegmonous adenitis 
(144), leukemic adenoma (5:}), lymphatisnms (35), bubo (36 bis), adenoma (46) 
lymphoma (46), lymphadenoma (46). ' 

Sri. Hemorrhage. — This title includes; Hemorrhage (without qnalification) in- 
ternal hemorrhage, hemophilia, ejwstaxis. stomatorrhagia, cutaneous hemorrhaire 
piirpura hemorrhagica. **■»«» 

This title does not include: Cere})ral hemorrhage (64) , cerebellar hemorrhaae 
(64), meningeal hemorrhage (64). pulmonary hemorrhage (99), hemoptyaia (S? 
hematemesis ( 104) , intestinal hemorrhage ( 100) , hematuria ( 121 ) , uterine hAnuwl 
rhage (135 or 128, according to whether it is puerperal or not), nietrorrhairf ri« 
or 125), umbilical hemorrhage ( 152). traumatic! hemorrhage (166). **«*«*» \m 

,sv;. Other discftses of the eirenlatory system. — This title includes: Card' « 

tions (not determined), angiectasis. angiectopia, affections of the larttS^^ ^^ 
I)ermanent slow pulse. ^ vesBiels, 

This title does not include: Vascular nevus (150). 

IV. niSKASKS OK THE HKSPIllATOHY SYSTEM, 

,V7. — Diseases of the nosal fossw. — This title includes: Gorj^za, '* colrl •• 
the nasal fossje (Jr nasopharynx, ozena, abscess of the nasal fossjfe n.?* ' I>OlvnnB«^ 
tions. '^^^xioieii^r*? 

This title does not include: Epistaxis (85), s>T)hilitic coryza. 
^'.v. Diseases of the laryna'. — This title includes: Acute, chroi 
edematous, phlegmonous, stridulous. etc.. laryngitis; aphonir 
voice, false crouj), spasmodic croup, stridulous croun. p 
of the glottis, i>olypus of the larynx, stenosis ^^ 
uA title does not include: TuVjercular laryngi 



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54 MARINE-HOSPITAL SERVICE. 

10:2, Diseasf^ of the esophagus. — This title includes: Foreign bodies in the 
esophagus, lesion of the esophagus, stt^nosis of the esophagus (except cancer), 
spasm of the esophagus, esophagotouiy. 

This title does not include: Cancer of the esophagus (40), syphilitic^ stenosis of 
the esophagus (86). 

J03. Ulcer erf the stojnach. — This title includes: Ulcus rotundum or round nicer 
of the stomach. 

Frequent complications: Hematemesis, perforation of the stomach, peritonitis. 

104, Other diseases of the sfoniaeh {except cancer). — This title inclnoefi: IMlata- 
tion of the stomach, paresis of the stomach, dyspepsia, apepsia, gastritis, gastro- 
hepatitis, foreign Ixnlies in the stomach, gastrotomy, nontraumatic i>erforation 
of the stomach, gastralgia. vertigo a stomaco heso, catarrh of the stomach, gas- 
trorrhea, indigestion. 

Also include under this heading the following diseases when their nature is not 
indicated: Gastrorragia, hematemesis. hemorrhage from the stomach. 

Note. — See observation made under No. 40 relative to organic lesion of the 
stomach. 

This title does not include: Gastroenteritis (105 or 106, depending on the age). 

Uf6, Diarrhea a nd en teritis ( under .2 years of age) . — This title includes: Q-astro- 
enteritis, or gastr(K;olitis of infants, infantile enteritis, cholera infantum, athrepsia. 

Note. — Class under this title only infants under 2 years of age. 

lO/t bis — of which: Chronic; diarrhea. 

This title includes: Athrepsia. 

100, Diarrhea and enteritis {.2 years and over). — This title includes: Gktstro- 
enteritis, or gastrcK-iolitis of adults, enteritis of adults, diarrhea of adults, lientery, 
intestinal ulcerations, colitis, int^istinal colic, colic of flatulency, inflammatory 
colic. 

This title does not include: Tubercular enteritis (29). 

107. Intestinal parasites. — This title includes: Helminthes, oxyures, tenia, tenia 
solium, ascaris lumbricoides, coenurus, trematoda, trichocephalus, ankylostoma, 
worm colic. 

105. Hernia, intestinal obstruction. — This title includes: Internal strangula- 
tion, intestinal invagination, stercoral tumors, ileus, intestinal occlusion, volvulus, 
hernial cholera, hernial gangrene. 

Include under this heading the following operations when their nature is not 
indicated: Merocele. sarcoepiplocele, sarcoepiplomphalus, kelotomy, herniotomy, 
artificial anus, sterconil vomiting. 

This title dm»s not include: Laparotomy (without other indication) (46). 

Frequent complications: Peritonitis. 

109. Other diseases of the intestines. — This title includes: Paralysis or x>are8isof 
the intestines, enteroptosis, constipation, stercoral fever, intestinal calculi, intes- 
tinal perforation, foreign Ixxlies in the intestine or rectum, rectitis. 

Also include under this heading thii following diseases and operations when 
their nature is not indicated: Euterotoniy, artificial anus, enterorrhagia, intestinal 
hemorrhage, melena, prolapse of the rectum, stenosis of the rectum. 

This title does not include: Sten^oral tumor (108) , intestinal invagination and ils 
synonyms (10^<), typhlitis (IIH), perityx)hlitis (118). 

100 bis. Diseases of the anus and fecal fistula. — This title includes: Proctitis, 
periproc;titis, proctocele, proctoptosis, fissure of the anus, abscess of the margins 
the anus, fistula in ano or stercoral or recto- vuginal. 

This title do<*s not inc^lude: Urinary fistulas, even when they connect "with the 
rectum (124), artificial anus (lOH) dor morbidity statistics only) , imperforate 
anus (150) (for niorlndity statistics only). 

110. Perniei(His icterus. — This title includes: Icterus gravus, acute yellow 
atrophy of the liver, parenchymatous hepatitis, Weil's disease. 

This tith? does not include: Icterus or jaundice (without qualification) (114) 
chronic ict^^rus (114). icterus of the new-born. Icterus ueonaionna (151). 

///. Hydatid tumors of the lin r. — This title includes the following diseases 
when their location is not indicated: Hydatid cyst, hydatids, echinoc^occus. 

/Ii\ ( 'irrhosisofthe lirrr. — This title includes: Cirrhosis (without qualification), 
alcoholic cirrhosis, interstitial cirrhosis, biliary cirrhosis, amyloid or fatty degen- 
eniticm of the liver, slow atrophy of the liver, steatosis of the liver, alcoholic 
interstitial or alcoholic, hepatitis. 

This title dfH*s not include: Organic lesion of the liver (114), hyiiertrophy of 
the liver (114). 

Frequent complications: Dro^)sy, hemorrliage, pneumonia, tul)erculo8is. 

113. Biliary calculi.— This title includes: Hepatic calculi, biliary lithiaais, 
hepatic colic. 



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This title does not include: Cancer of the testicle (45) , tnbercle of the testi 
(3;J) , varicocele (85), sarcohydrocele (45), syphilitic sarcocele (36) , spermatorrh 
varicocele (83). 

127, Metritis. — This title includes: Ulcer of the uterus, ulcerations of the ne 

IxfS. Uterine hemorrhage {not puerperal). — This title includes: Metorrhsj 
menorrhagia, tamx)onnement of tne vagina or of the uterus. 

JJV. Uterine tumor {not cancer) . — This title includes: Uterine fibroma, fibn 
tumor or fibroid bodies of the uterus, hysteromyoma, uterine polypus, fongofl 
fungosities of the uterus. 

ISO. Other diseases of the uteruft. — This title includes: Ulcerations of the ne 
uterine or vaginal catcurrh; deviation or antiflexion, retroflexion or antiversion, 
retroversion, or falling down or prolapse of the uterus; prolapse of the vagi 
elongation of the uterus; amenorrhea; hypertrophy of the neck of the atems; d 
menorrhea; organic lesion of the uterus; hysterectomy; hysterotomy; metrotoo 
ablation of the uterus; jielvic abscess; i)eriuterine ahecess or phleKmon or rec 
uterine; pelvic suppuration; Huguier's disease; leucorrhea; ** whites;'" vagi 
discharge. 

This title does not include: Puerperal diseases, abscess of the iliac fossa (95) 

JJJ. Ovarian cysts and other tumors of the ovary. — This title includes: On 
otomy, castration (in the female). 

JJ:J, Other diseases of the female genital oi^gans. — This title includes: Vag^uu^im 
tumor of the vagina, ovaritis, salpingitis, salpinx, metrosalpingitis, hematO£ 
pinx, pyosalpinx, abscess and cysts of the vulvo- vaginal glanos, vulvitis, periut 
me hematocele or retro-uterine. 

This title does not include: The urinary fistulas (124) and the fecal fistulas ( 
bis) , even though they be connected with the genital organs. 

i/yj. Diseases of the breast , n ot puerperal { cancer excepted) . — This title includ 
Mammitis, abscess of the breast (not puerperal) , cyst of the breast, cystic dise 
of Reclus, tumor of the breast (not cancer or without indication), ampntat 
of the breast. 

This title does not include: Mammary fistula (puerperal or without indicati( 
(141), cancerous tumor of the breast (43). 

VII. -PURRPKRAJ^ CONDITION. 

Note. — It sometimes happens that the physician neglects to note the charac 
of the puerperal disease. In this case employes whose duty it is to compile i 
statistics will be guided by the following: *• In every case in which anadnlt fern 
is rejwrted as having died of a disease which might be of a puerjieral charact 
the certificate of death should be returned to the signer for explanation as 
whether the disease was puerperal or not. These diseases are" the foUowii 
Peritonitis, pelviperitonitis, metroperitonitis, septicemia, hemorrha^^, metr 
rhagia, eclampsia, phlegmasia alba dolens. phlebitis, lymphangitis, embolus, si 
den death, abscess of the breast.*' 

LU. Accidents of preanancy. — This title includes: Abortion or miscarrii 
(death of the mother) , hemorrhage during pregnancy, uncontrollable vomiti] 
rupture of tubal preguancry, a})lation of the gravid tube, troubles and fotigi 
intervening in the course of pregnancy. 

I.i4 his. Normal hdntr. — (For morbidity statistics only.) 

i./.'T. Puerperal hemorrhage. — This title includes: Puerperal metrorrha^^. 

IM. Other accidents of Udwr. — This title includes: Dystocia, Cesserian ope 
tion. rni)ture of th(^ uterus, nietrorrhexia, tearing or rupture of the perineum, pi 
neorrlmphy, plm'eiita pnevia, mali)osition or retention or detachment or apoplc 
of tht» placenta, ccphalotripsy, em}>ryotomy (adult female), symphiseotomy, v 
sion. appliciition of the forceps, uterine inversion. 

/./;. Puerperal septicemia. — Tliis title includes: Puerperal fever; puerpe 
infection; i)neri>eral endometritis: puerperal wilpingitis; perimetro-salpingitS, 
phlegmon (a})sc^»ss) of the broad ligament or diffuse puerperal pelvic ^3lnli1 
jieritonitift, or metroperitonitis, or phlebitis, or lymphangitis, or pnerpe 
pyoheniia. 

This title does not include: Septicemia (without qualification) (20). 

138. Puerperal tdhuminuria and eelampsia. — This title includes: Paerpe 
uremia, nephritis of i)regnancy, eclampsia gravidarium, epileptiform convnlsk 
of women m pregnancy, ])uerperal tetanus. 

l,ifK Puerperal phlegmasia allnt dolens. — Fre<iuent complications: Ckm^preo 
emlM)]i. 

This title does not include: Nonpueri)eral phlegmasia alba dolens (82). 

140* Other accidents of the puerperium — sudden death. — This title includ 



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58 MARINE-HOSPITAL SERVICE. 

nontraumatic, diseases of the tendons, tenox)hyt«s, tenosyiioA-itis, tenotom] 
tenorrhaphy, torticolis, lumbago, curvature. 

X.— MALFOUMATIONS- 

150, Conffenitalmalforrnatiotis (stillbirths 7iot included), — This title include 
Malformation, monstrosity, anomaly, arrested development, congenital hydn 
cephalus, hydrocephalus (without qualification), megalocephalns, hydroracfai 
spina bifida, encephalocele. podencephalous, congenital eventration, omphalocd 
exomphalous, ectopia, imperforate anus, etc., hare lip, amispadias, hypospadift 
cryptochidism, vascular nevus, polyda(!tylism. s>'ndactylism, copgenitaf clubfoot 
talipes varus, valgus, or equinus, congenital deafness, or blindness, persistence ( 
the foramen ovale. 

This title does not include: Colomboma (75), flatfoot x>Ainfnl valgpis (14tj 
acquired hydrocephalus (T4c). 

XI.— DISEARKS OF INFANCY. 

150 bis. Births (children born in hospital and lea ring the hospital trithm 
having l>een sick) — (For morbidity statistics only). 

151, Congenital debilitij — icterns and sclerema. — This title includes: Prematnr 
births, atrophy (infantile) , icterus or hepatitis of the newly bom, atelectasis of tii 
lungs of the newly bom. edema of the newly l)om. 

Inote. — Under this title only compile children under three months old. 

152, Other diseases pecidiar to infancy. — This title includes umbilical hemM 
rhage, inflammation or the umbilicus, cyanosis of newly bom. 

Note. — Under this title only compile children under three months old. 

153, Neglect. 

Xn.— DIBEASBH OF OI.D AOK. 

154, Senile debility. — This title includes: Senility, old age, senile cachexia, seiril 
exhaustion, senile dementia. 

This title does not inchide: Senile grangrene (142). 

XIII. -EXTKHNAIj vioi.knck. 

Note. — Among suicides should l>e classed only cases which are definitely state 
as such, or which result from suicidal atteiii])ts. 

Among the suicides compile only individuals over the age of majority. Minoi 
should 1)6 regarded as victims of assassination. 

155, Snicide by 2>oison, — This title includes: Voluntary poisoning, "willfiil taiHq 
of sulphuric acid or any other corrosive substance. 

This title does not include: Morphinism (oO), cocainism (50). 

15r,, Snicide by asphy.via. — This title includes: Suicide by burning charcoal. 

In'fT. Snicide by hanging or strangling. — This title includes: Hanging^. 

I5S. Suicide by drowning. 

15'J, Suicide by firearms. 

100. Suicide by cntting instruments. 

101, Suicide by precipitation from height, 
lOJ, Suicide by crush ing. 

lO.i. Snicide by other means. 

104. Fractnres. — This title includes: Detju'hnient of the epiphysis, fractnno 
the cranium. 

I05a. Sj)rains. — This title includes: Distension of the ligaments. (Por moi 
bidity stiitistics only,) 

lOOb. Di.HliH'ations. — This title includes: Luxation and subluxation. 

100. Oth(*r tranniatir arridnits. — This title includes: Stabs by cutting instn 
iiH'nti), contusion, bite (neither venomous nnr virulent), crushing, railroad aod 
dents (except sniciu< ). injury ]»y cutting instruments (without evidence fl 
suicide), acx-identul fall, concussion of the brain, ])erf()ration of the skull, tm 
matic hemorrhage, traumatic fever, traumatic eventration, perforation of ft 
alMlomen or chest, all jicute affections (jualified "traumatic." wounds by fiream 

10:. Hums by fire. — This title includes: Bums by boiling water, steam, petti 
leum. 

This title d<H»s not include: C-onflagration (174). 

//;.v. Hnrns by rornisirr stibsfances. — This title includes: Bums by vitriol. 

I0!t, Insolation. — This title includes: Sunstroke. 

17a. /'Vvr^/z/f/.— This title does not include: Cold (newly Ik >rn) (158). 

171, Electrical shuck. — This title includes: Lightning. 



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no MARINE-HOSPITAL SERVICE. 

' ilKATinS or AN I.N'TKICN'ATinNAI. BI'KEAl' «.»K STATIHTirAli HKllOaRAPHr. 

'Kxtnwt fr«iin th»''iir«n.'».'«'din>r!*/ 

M. Hnizhif<H Ofolland; proTKjM.^s that the BtatisticH kept in conformity withoj 
wnn'rwiliiiurfH ]trii]MTf'A by the inteniationHl commission shall be centraliiedi 
an iriti;rrjHtiorial bureau of HtatiHtical di^mography. which 'will have char^i 
f4rtniinrintiUtmit\<}iO*'ii\ Ktatistics. as to their uniformity: of Tecei\'iiiK thecritui 
whirh Mhall Ik; iriiule on the work of tlie commission, and thereby prepare* 
fttr thi? di^:<'ririial reviHioii, whicrh is to take i)lace in 1900. 

Thiit profKiHition was unanimously iulopted. 

M. Hiiizinxa Hlolland) then moved tluit this bureau of international statiitio 
demography Ix; at. Paris, and that M. Jacciues Bertillon be charged witki 
tWrt^'.i'iou. 

This inolioii was unanimously adopted. 

M. Jiuupies I^!r1ilIon( France; thanks the international couunission for the 

tiroof of f'onridence which is i^wu him, and declares himself prof onndly tonck 
le lufkH that the (tommlHsion st^it^^ with more precision the services expected : 
hirri. In ordiT that hn may thf lN^tt^*r fulfill his duties. 

Mr. I'ri'Mideiit explains that Dr. B(»rtill(m shall have to receive the 
d'Mtiimentri miide in conformity with the nomenclatures adopted by the come 
sion; to di't^*rniin(* wh(;ther involunmrily the compilers of these statistics btf 
dooartiH] from the rules ]>r(^scnlKMl by the commission, and in snch case toDii 
It Known Ut them. 

Ill) will Kiv(« explanations to thoH(> seeking information. He "will receive ik 
nimarks wldch comiK*t<}nt authorities may formulate in the work of theoa 
nilsHJon. 

The liit4trnational cumimission approvt^l thi^ programme outlined by the 

hKATIIS .\TTItimiTKI) SIMUI.TANKOUSLY To TWO CAU8B8. 
TAIILKH INI>l('ATI.NO HoW TIIKY HHOl'Iil) BK triJlSSKD. 

It. ha])iNMiH V(>ry oftvn that, a diMith is attributed by the physician to two cfli 
at tht« wini«« tiuKV 1low<»ver, it is clear that the death is to be counted only an 
To which of the two caus<*s shall it be attributed? 

Very oft«*n the answer to this tpiestion is given by the phvsician himself. Ifi 
wi'lt«»H, for(»xamph\ ** rhiMinmtic j>h*urisv," or "pleurisy following^ rhenmatioi' 
there remains no doubt as ti> which is tlit> cause of death. But eases where tf 
disiMisesare indicated at the samt* tini«\ without any ties connecting^ them, reqov 
our siHvial attention. 

Mivst. friH|uently in such civses tmt* of the two diseast^s is only a complicatian^ 
the i»ther. Tlu* custunuirv ]>nK*eeding is to n«iM>rt the death as due to &e prinU! 
diH«taiie, i. e.. to the one wliich has brought aluMit the other. But as the registf 
iMUot. as a rule, a phvNii'ian. it is pr(»]M>r to guide him in det^^nnininK theprintf! 
diMcase. This \h one of the reiisons for making the s^Hvial table which follovi 

ThtM>i* are other n^aMoiis. It may li:i])]M'n that two diseases given as caufla< 
death have no conmvtion whatever with each other. There is nothing^, inW 
t\^ pn*\ent an individual HutTering from cirrhosis of the liver f rom contractii 
txi^hitid fevrr. although those diseasrs havi' no conntvtion with each other and^ 
not di'p^'ud u|»i»n each other. Thrre is nothing to ])n»vcnt him from breakiiigti 
U':; :»nd dyiui; t'roni the elTi'cts. Thrri' is not him; to prevent him from oomminB 
M1U idc tor thi' phxsic.'it jiuil moral Mitlrniigs. the misery which resnlts fxomk 
d'.M\»M\ ihe \u'i' ilsi'lt' wlnrli lausi'il u. lax or this dismal resolution. To whidK 
tlicM* c;r.is,«s of death so tb tin cut Ironi facli \^i\wv should the death lie atMbolf 
^tj tl'.c N'ati'.tu •» NVhatexrr sobitioii ol (his ipirstion i> adi^pttnl it is prefoiV 
that tli'.«. N.^hition be iintt'ovni 

It l-.as N^ II dis idrd. ihon. to antiiipate and ttM'ormulato in advance all the potf 
bii' autl iina&;it\;)bli' « a^'N \\\ ^\u\\ a \va> tli:)t lh<« mtcrnaTif>nal statistics mayKl 



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O. 61. I^a. I^J. '»4 Vf '^ ••. r«. • . flj t| •.. t#. r, ^4/ .. ., f. ■* 



62 MARINE-HOSPITAL SERVICE. 

79, 80. 81, 82, 88, 84, 85, M, 91. B2, 93, 94, 95, 90, 97, 9». IMI. IIW. lO-l, 106, 107, 108, 110, 1 
112,118, 115. 116, 118,119, 130,123, 134,12.1,127, 128,130. 1.1I, 133, 184, l;«>, 136, 1: 
138, 139, 140. 141 . U3, 14,1, 144, 146, ir>4, from 155 to 176. 

a.— 3,4,5,6,7,8,9,10,11,13,13,14,15. 16. 17, 18,20,21.33,23,24,20,26,27,; 
28, SO, 31, 33, 33, 34. %1, 36,^7,38, 38, 40,41, 42, 43,44, 45,46. 47, 48.4»,. 
B1,B3,63,54,H. 66,57.60,61, 62, 64, 65. (t«, 67, 68, 69, 70,71, 73, 73. 75, 76, 77. 78, 
80,81,82,83,84,85.90,01,03,93,94.9.1,96,97,98.1)11, 103, 105, 106, 107, 108,110,1 
113, 113, 115, 116, 118, 119. 120, 122, 1 34, IW. 137. 138. 129. 131. 133. 134, 135, 136, 11 
138, 139, 140, Ul . 142, 143. 144, 14fi. 154. from 15.5 to 176. 

3 4,5.6.7,8,0,10,11,12,13. 14. 15, 16, 17.18,20,21,22,23,24.35,26,; 

28, 29,30, 31,32, 33, 34, 35,:i6,:i7.:]8. 39,40,41,42,43,44, 45, 46,47, 
49, BO, 51 6a, 53, 54,55,56.57.80.61,83, 64,6'>. 86. 67, 68. 60,70,71,72.73,75, 
77 78, 79,80, 81, 83,83, 84,85,90,91 93, 93, 94. ft5. 96, 97, 88, 09, 103, 105,106,1 
108, 110,1 112,113.113,116.118, 119,130,132,124.125,137.128,129,131,1 
134, 135. ISe 137, 138, 139, 140, 141. 143, 143, 144, 146, 150, 151, 152, 158,1 
from 156 to 176. 

J.— 5,6,7,8.0, 10, 11,12, 13,14,15, 18, 17, 18,20,21, 22,23,21,^5,26, 27,1 
29,30,31, 32, 33, 34,35,30,37,38, 38,40,41,42,43,44,45,46.47,48, 
60,61,52, 53,. ->4.55, 56.57. 60, 61. 62, 64,65.66.67,68. 01', Tit, 71.73.73,75,78. 
78,79,80.8i.Ha,83,84,8.5, 90, 9I.93.93,04,9.'i,96,97,9ft.1)i), 103, 1(15.106,107,11 
110,111. 112,118, 115, 116, lis, 119, 120,122, 134, 125, IL'T, US. 138, 131,1 
184, 18.5,136, 137, 138, 139, 140, 141, 142, 143, 144. 148, !.^0. i.-il, i.v>, 153. 154, ft 
165 to 170. 

5 6,1',S,9.10, II, 12, 13. 14, 15, 16, 17,18,30, 21,23.33,24,25,26, 27,1 

28, 30, 31, 33, 33, 34, 3.^i, H8. 37, 38. 39, 40, 41, 43, 43, 44, 45, 46, 47,48, 
60, 61, 62, 53, 54, .W, -50. 57,60, 61, 62, 64, 65. 66,67,68.69,70,71,72,73,75,76, 
78. 79, 80. 81, 82. 83. 84. 85, 90, 1)1, 92. 93. 84, 95, !16,!i;, M. SO. li):). 10.5, 106, 107,108,1 
111,112,113.115.118,118,119.130,123.134, 135, lUT, KM, 1311. 181,133,134,135,1 
137, 188, 130, 140, 141, 142. 143, 144, 146. 150, 151, ITiS. |.>3. ir,i. from 155 to 176. 

6.-7,8.8, 10,11, 12, 13, 14, 16, 16, 17, 18.30. 21, 22,23,24,26, 26,; 
28,29,30,31, 32,33, 34, 85,36 37. -t^J, 38,40,41,42,43,44, 46,46, 
48,49,50, 51,52, 53, 54.55.50. .57, 60, 01 63,64, 85,06.07,68,69,70, 71,73, 
75,78,77,78, 79, 80, 61,82, 83,84,ft5, 00.91, 93, 93.94,05.96,97,98,99, 109,11 
106,107,108, 110,111,112,118.115.116,118,119. 120. 122,124,126, 137,1 
129,131, 133. 13-1.135. 130.137, 138,139, 140,141,143.143,144.146,150,151,1 
158, 154. from 165 to 176. 

7 8,9,10,11,12,13,14, 15,16,17,18,30,21,22, 23,24,25,26, 27,28,; 

30,31,32,33, 34, 35,30, :i7, 38, 39, 40, 41, 43, 43, 44, 45,46. 47, 48. 49. 60,1 
63, 63, 54, 55, 56, 57, 60. 01 , 83, 64, 65. 66. 67. 68. 68. 70. 71. 73. 73, 75, 76, 77, 78, TO, 
81,82,88,84,85,00.91.93, 83, 04, yo, 08,97.98,99. 103, 105, 108.107,108,110,111 1' 
118.115,116,118,119,130.122,134.125.127, 128, 129. 181, 133,134.1&5.136, isll 
139, 140. 141, 143. 148, 144, 146, 150. 151, 152, 153. 154, from 155 to 176. 

8.-9,10,11.13, 13, 14, 16, 16,17,18,20.31,22,23,34,25,26,37,28,: 
30,31,32,33,34,35,36,37,38.39,40,41,42.43,44,45,46,47,48,48,50.1 
63, 63, 54, M, 56, 57. 60, 61. 63, 64, 0.5, 60, 67, 68, 68, 70, 71, 73, 73, 75. 76, 77, 78, ! 
80,81,82,83,84,85,90.91,92.03,94,95,06,97.98,99,103,105,108,107,108.1: 
111, 113, 113. 115, 118, 118, 110, 130, 122, 124. 126, 127, 128, 120. 131, 133, 184. 1 
186,137,138.139,140,141, 143, 143, 144, 146, IBO, 151. 1.53,153. 154, from 15! 
176. 

».— 10.11,12,13, 14, 16,16,17,18,30,31,22,23,24.25,26,27,28,28.1 
31,32,33,34,85, 36,87,38,39,40,41,42,43,44,46,46.47,48.48 60,1 
62, 63, 54, 55, 50. 57. 00. 61. 82, 84, 65. 66. 87, 88. 69, 70. 71. 73, 7;{, 75. 76, 77, 78 fll 
81. 82.83.84, 8.5, 90, 91, 83, 83. 94.95,96, 97.98,99.103,105, 108, 107, 108,110,111.1] 
113. 11.5, 116, 118, 110, 120. 122. 124. 125, 127, 128. 130, 131, l.'KJ, 184, 135, 136, 187, 1 
139, 140. 141, 143. 143. 144, 146, l.W. 151. 153, 153, 154. from 1.55 to 176. 

lO.— 11. 12, 13, 14, 15, 16, 17, 18. 20. 31, 22, 23,24, 26, 36, 37, 88. 20.] 
31,32,33,34,35,36,37.38,39,40.41,42,43,44,45,46,47,48.49,60,51,1 
63, .54, .W. .56, .57, 60. 61 , 82, 64, 66,68, 67, 68. 60, 70. 71 . 73. 73, 7.5. 76. 77. 78, 78.1 
81,82,83,84.8.5.90.91,92,93.94,95,06,97,98,99. 103,105,106,107,108 110 1 
112,113.115.116,118,119.120,122.134, 126, 127. 128, 138.131,133,134,135 ] 
137, 138. 139, 140, 141, 143, 143, 144, 146, 1.50. 151, tw, 1.53. 154,from 155 to 176. 

1 1 12, 13, 14, 15, 16, 17, 18,20, 21, 22, 23,24, 25, 26, 27, 2S. 29. 80,j 

32,33,34,35,36.37.38,39,40,41,42,43,44,46,48,47,48.49.50,51,62 i 
54,55.56, 57, 60. 61, 63, 64, 65. 86, 67, 68.69, TO. 71, 72. T3. 75, 7li, TT. 78. 79. f 
81,82.83,84.8.5.90,91.92,93,94,05,98.97,88.90.103, 105,100,107. 108 11 
111,112,113,115, 116,118,119,120, 133.134,126,127,138,138.131,138 1 
135, 186, 137, 138. 139, 140, 141, 142, 148. 144, 146, 150, 161, 152, 153, 154, from 15! 



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64 MARINE-HOSPITAL SERVICE. 

127, 128, 129, 131, 183, 134, 135, 136, 137, 138, 139, 140, 141, 142, 148, 
144, 146, 160, 151, 152, 153, 154, from 165 to 176. 

36 37, 38, 39, 40, 41, 42, 43, 44. 45, 46, 47, 48, 49, 50, 61, 62, 63, -U 

55, 56. 67, 60, 61, 62, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 75, 76, 77, 78, 
79, 80, 81, 82, 83, 84, 85, 90, 91, 92, 93, 94, 95, 96, 97, 98. 99, 108, 
105, 106, 107, 108, 110, 111, 112, 113, 115, 116, 118, 119, 120, 18S, 
124, 126, 127, 128, 129, 131, 133, 134, 136, 136, 137, 138, 139, 140, 
141, 142, 143, 144, 14«, 150, 151, 152, 153, 154, from 165 to 176. 

Note. — This does not include acauired syphilis (adults). Hereditary ayphilu 
of infancy is a disease much more often fatal. 

37, 3§. — Diseases enumerated in the development are tlie only ones that should 
be compiled under these headings. In all other cases, where two dia^^osee arp 
indicated simultaneously the bulletin should not be compiled under these headings. 

39-46* — By reason of the extreme seriousness of these diseases, all bnlletins. 
without exception, which make mention of them should be compiled under th«r 
headings, 39-46 (exceT)t deaths by violence) : however, inanition can only be a coo- 
sequence of cancer of the stomach. 

47.— 4H, 49, 60, 51, 52, 53, 54, 55, 56, 57, 60, 61, 62, 64, 65, 66, 67, 68, 
69, 70, 71, 72, 73, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 90, 91, 92, 98, 94, », 

96, 97, 99, 103, 105, 106, 107, 108, 110. Ill, 112, 113, 116, 116, 118, 119, 
120, 122, 124, 125, 127, 128, 129, 131, 133, 184, 135, 136, 137, 138, 139, 
140, 141, 142, 143, 144, 146, 154, from 156 to 176. 

4§. — The diseases enumerated in the development are the only ones which 
should be compiled under this heading. In all other cases where chronic rhen- 
matism or gout are given simultaneously with another disease, the bnlletin sbonld 
not be compiled under this heading. 

49. — This rare disease should be recorded every time it appears. 

50, 51, 52, 53. — By reason of the extreme seriousness of these diseases, all 
bulletins which make mention of them should be compiled under their headings 
(except violent deaths, from 156 to 163 and from 166 to 176). 

54. — Pernicious anosmia should always be classified under this heading, even if 
it is complicated with another disease. 

On the contrary, anaemia (without qualification) and chlorosis, whenever they 
are mentioned in conjunc^tion with another disease, are more often only a con- 
sequence. The bulletin should then b*» compiled under the heading of the other 
disease. 

56* — This intoxication characterizes the disease less completely than the dis- 
eases more exactly si)ecified, even when these diseases come from alcoholiBiD. 
For example, the words "cirrhosis of the liver" characterize a disease better 
than the vague mention of "alcoholism" does. Therefore any other diagnosis 
should be preferred to this one. 

57.-58, 59, 60, 61 , 62, 64, 65, 66, 67, 6«, 69, 70, 71, 72, 73, 75, 76, 77, 78, 79, 80, 
81, 82, 8:^, 84, 85, 90, 91, 92, 9;^ 94, 95, 96, 97, 98, 99, 103, 105, 106, 10?; 108, 
110, 111, 112, 118, 115, 116, 118, 119, 120, 122, 123, 124, 125, 127, 138, 129,181, 
133, 134, 135, 136, 137, 138, 139, 140, 141, 142, 143, 144, 146, 154. from 165 
to 176. 

5§, 59. — It is impossible to give detailed rules for headings so general <m^ 
which include such varieties of intoxication. The development of the headings 
must be consulted and the same rules applied as in the case of lead poisoning. 

60.— This heading should l)e avoided. 61, 62, 64, 66, 66y 67, 68, 69770,71, 
72, 73, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 90, 91, 92, 93, 94, 96, 86. 

97, 98, 99, 103, 106, 106, 107, 108, 110, 111, 112, 113, 115, 116, 118, 
119, 120, 122, 124, 125, 127, 128, 129, 131, 133, 134. 135, 136, 137, 188, 189, 
140, 141, 142, 143, 144, 146, 154, from 155 to 176. 

61. — By reason of the extreme seriousness of this disease all bulletins which 
make mention of it should })e classed under heading 61 (except when mening^itb 
is in the development of another disease cited as being a fre(iuent complication of 
this disease). 

62. — The above applies to tliis heading also («'X(-e]>t suicides and other violent 
deaths ) . 

6JI. — It is impossible to givf; detailed rules for a heading so general. 




176. 

65 — 66, 67, 6J^, 69. 70, 71, 72, 73, 75, 76, 77, 78, 79, 80, Hi. 82. 83, 84, 85, 86. 
87, 8H, 89, 90, 91, 92, 93. 94, 95, m, 97, 98, 99, 103, 105, 106, 107, 108, 110, 111, lls! 
118, 115, 116, 118. 119, 120, 122, 124, 125, 127. 128, 129, 131, 133, 142, 148, 144, lA 
154, from 166 to 163, 164, 165, from 166 to 176. 



J 



^ \UIN'» lli-ri I M <•» K\ H » 



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L #17. flH. t1l#. ' ';7. 7N. 7M. hU. Nl. n:8. h:i.H4.o< '•• 

• \*i\, ' •" '■ U».i. io.%. io«. • ■■ lUH. 1 lO. 1 I 1. 1 I'J. I i:i, 

I l.'«. I 1ft. 1 IH. 111*. i;!(). lU-J. I'i-I. I'JA. : -: K'-i rjK. i:il.:. I:i4. i:iA. 

|:IH. 1 17. I.IH. l.tii. I40. 141. I -4 144. MM. I AO. lAl. lA'J. \\ 1 A4. 

•• ir»fi' lii;i. ••■4 :•.. 'r .111 IHil *. 17cS 

•7. •- ' ' . :'. :» . ; " * • » *.■ •»: -. * . -■ -.•.■•■ •#.■■■•; 'ii. 

• ml.- •«• '• loft, ■■*. ■ •* • lia. .■ •:•■ - 11». 

I'jn i \'Jtr», * i-jw. i.ti. i:i4. I.'IA. i:iM. i:i7. 1:ih. i:ii», 

ll< 1.111. 144. !«'• i f? ti^AA t. I7<l. 

• *. • ' . :. .'. 77.7h. 7». HO. HI. HJ.H.I. H4. •. iH).|ll.||-J. 

w I. »M. II'.. »Mi. f»7. WH. »»». ii):i. \iM%. : ii»N. 1 lo. 1 1 1. I I'j. I i:i. 1 lA, 
1 i'( I IH. I 111. 1-jii. 12*4. : I I'jri. :^ 1211.1.11. l:i4. l:iA. i:iii. 

11'.. 1 IH. 1 HI. 14(). 111. I. 14.1. 144. 14<«. ' 'i ?r I . lAA • 17fl 
••■ : .' 77. 7H. 711. HO. HI. Ha. h;i. H4. ' ■ l*0. HI . ii2. W.'l. 

Ml. H'.. I»M. U7. »»S. |«ll. lO.i. lOA. llM!. ' lOH. 1 lO I 1 I. I 1 J. I 1.1. 1 lA. 

IIH. US Mil I'.Mi. IJ'J. I laA. « I'JM. l.il. i:il. l:«A. I.IH. 

MV. I IS. I III. 1 U>. I II. ; 14:1. 111. im. .1 'r : 1 AA ■ I7tl. 
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; '• . •• 11. MS. I IH. 111. . 14 I I II. -• ' 1 •••. 1V«* 

«l • ml. - *■• li'fi • 1"*«. iiu in. 

11.' Mi« 1 IS. 1 111. I'io. I'J'J. l'J4. la.'.. ' Un Ml.lM. 

■ I «•-. I IV lis. I.ui. . 141. .4. 141. I4«. 4' 4 • I'.r. • 

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66 MARINE-HOSPITAL SERVICE. 

106.— 107, 108, 110, 111, 112, 113, 115, 116, 118, 119, 120, 122, 
125, 127. 128, 129, 131, 133, 134, 135, 136, 137, 138, 139, 140, 141 
143, 144, 146. 154, from 155 to 176. 

107.— 108, 110, 111, 112, 113, 115, 116, 118, 119, 120, 122, 124, 
127, 128, 129, 131, 133, 134, 135, 136, 137, 138, 139, 140, 141, 
143, 144, 146, 150, 151, 152, 153, 154, from 156 to 176. 

10§ 110, 111, 112, 113, 115, 116, 118, 119, 120, 122, 124, 125, 127, 12 

131, 138, 134, 136, 136, 137, 138, 139, 140, 141, 142, 143, 144, 146, 150, 15 

153, 154, from 166 to 176. 

109. — ^It is impossible to give detailed roles for headings so general. 

IIO 111, 112, 113, 115, 116, 118, 119, 120, 122, 124, 125, 127, 121 

131, 133, 134, 135, 136, 137, 138, 139, 140, 141, 142, 143, 144, 146, 150, 
152, 153, 154, from 156 to 176. 

Ill 112, 113, 115, 116, 118, 119, 120, 122, 124, 125, 127, 128, 129, 13! 

134, 136, 136, 137, 138, 139, 140, 141, 142. 143, 144, 146, 154, from 1 
176. 

Iia.— 113, 115, 116, 118, 119, 120, 122, 124, 125, 127, 128, 129, 131, 133, l^i 
136, 137, 138, 139, 140, 141, 142, 143, 144, 146, 154, from 155 to 163, 16- 
from 166 to 176. 

113.— 116, 116, 118, 119, 120, 122, 124, 125, 127, 128, 129, 131, 131 

136, 136, 137, 138, 139, 140, 141. 142, 143, 144, 146, 150, 161, 152, 15: 
from 166 to 176. 

1 14. — It is impossible to give detailed rules for headings so general. 

115.— 116, 118, 119, 120, 122, 124, 125, 127, 128, 129, 131, 138, 134, !» 
137, 138, 139, 140, 141, 142, 143, 144, 146, 154, from 155 to 163, 164, 165, 
166 to 176. 

116.-118, 119, 120, 122, 124, 125, 127, 128, 129, 131, 133, 134, 135, 

137, 138, 139, 140, 141, 142, 143, 144, 146, 150, 151, 152, 153, 154, from 1 
163, 164, 165, from 166 to 176. 

1 17. — It is impossible to give detailed rules for headings so general. 
11§.— 119, 120, 122, 124, 125, 127, 128, 129, 131, 133, 184, 136, 136, 137, 

139, 140, 141, 142, 143, 144, 146, 154, from 155 to 163, 164, 165, from H 
176. 

119.-120, 122, 124, 125, 127, 128, 129, 131, 133, 134, 185, 136, 137, 138. 

140, 141, 142, 143, 144, 146, 154, from 155 to 163, 164, 165, from 166 to 
130 — 122, 124, 125, 127, 128, 129, 131, 133, 134, 135, 136, 137, 138, 139, 

141, 142, 143, 144, 146, 154, from 155 to 163, 164, 165, from 166 to 176. 

131. — It is impossible to give detailed mles for headings so general. 

laa.— 124, 125, 127, 128, 129, 131, 133, 134, 135, 136, 137, 138, 139. 
141, 142, 143, 144, 146, 154, from 155 to 176. 

123. — It is impossible to give detailed mles for headings so general. 

104 — 125, 127, 128. 129, 131, 133, 134, 135, 136, 137, 138, ISO, 140, 
143, 144, 146, 154, from 155 to 176. 

135 — 142, 143, 144, 146, 154, from 155 to 163, 164, 165, from 166 to 1 

136. — It is impossible to give detailed mles for headings so general. 

127.-128, 129, 131, 133, 134, 135, 136, 137, 138, 139, 140, 141. 
143, 144, 146, 154, from 155 to 176. 

12§.— 129, 131, 133, 134, 135, 136, 137, 138, 139, 140, 141, 142 
144, 146, 154, from 156 to 176. 

129 — 131, 133, 134, 135, 136, 137, 138, 139, 140, 141, 142, 148, 144 

154, from 155 to 163, 164, 165, from 166 to 176. 

1 30. — It is impossible to give detailed rales for headings so general. 
131 — 183, 142, 143, 144, 146, 154, from 155 to 163, 164, 165, from 166 to 
1 32. — It is impossible to give detailed rales for headings so general. 
133.— 134, 136, 136, 137, 138, 139, 140, 141,142,143,144,146 

151, 152, 153, 154, from 155 to 176. 
134 — 142, 143, 144, 146, from 155 to 163, 164, from 165 to 176. 
135.— 136, 137, 138, 139, 140, 141, 143, 143, 144. 146, from 165 to 163 

165, from 166 to 176. 
136 — 137, i:^, 139, 140, 141, 142, 14:^, 144, 146, from 155 to 163, 164 

from 166 to 176. 

1 as.— 139, 140, 141, 142, 143, 144, 146, from 155 to 163, 164, 165, from 1( 

176. 
139 — 140, 141, 142, 143, 144, 146, from 155 to 163, 164, 165, from 166 to 
140 — 141, 142, 14:^, 144, 146, from 155 to 163. 164, 165, from 166 to 17( 
141.— 142, 143, 144, 146, from 155 to 163, 164, 165, from 166 to 176. ■ 
142.-143. 144, 146, 150, 151, 152, 153, 154. from 155 to 163, 164. 

from 166 to 176. ^ 



MAlUlfK*l|iiKnTAL HKKVirK. Il7 

1«9. 144, 146, IM, fnioi 166 i.* 169, IM. IV». fn«i 166 t^. 176. 

144. 146, 160. 161, 16S, 166, 164, frtioi 166 t«» 176. 

1 46. It u itti|Ba«itl4«> t«i irtTi* clrtalM rnlra ft>r bi^lnM* •>» nrfinml 

146. r*l. fr^itn 166 t<> 166, l«M. IVi. rr««i 166 tii 176. 

147, 14«, 146. It U tasi>a«ll4«*t«>irt%«*<lruUM mlrafi*' bi-wlttuc* «*ic« tM*nU. 
166. IM IV! 1\3. liM. 14%. friMii 166 ti» 176. 

161. 16S, l\.i. 164, 166, fn«i 166 t<> 176. 

166. IVl. 1«M. 14.% fnia 166 !<• 176. 

166. tM. 14%. fn«i 166 to 176. 

164. rnia 166 t«> 166, l«M. 14%. fruni 166 t«> 176. 

166 166. 141. 14%. im, 147. I4W. im. IM. 171. IT?. i:;t. 174. 17%. I7il 

164 166. 166, 167. 1^ \m 170, 171. I7S, 178, 174, 176, 174. 

166. 167, 14N. \m. I70. 171. 176, I7l. 174, 17%. 174. 

167. 1*1^ \m, I7«, 171. 171, I7S. 174, 17%. 174. 
16%. i«. i:o. i:i. 171, 173. i:i 176,176. 

166. i7i» iTi. 171. 171, 174 i:% \:n 

I7«. ITI 171, 173. 174 17% 17* 

Bttrari fr»«» iW |^« 



lYi ■(•«■■«' itr«>nAnlrl **f th«* itifltUnt** in tbi* rliAir 

«^ AatfY»<*t :\ . \W*. thf* itit^niAtkmal «>ittitiiu«ii««i « hATtfv*! t<* ni*vtM> tKr i»i«i««- 
rlAlisrv* • if thf* «maflra «*f «l««itli m«*t tti full «>^«iiii»n at -1 «* «*)iB-ii |» lu in th#> rpinilAr 

.tN«#ri«i In ^M^filuui*- SnlUrark. |iiQntrt|«l r«mnflrliir. illrnrVir nf tb^ vlAtU 
IItaI tUfArtmrnt of ih«* <-ttv of V»»-nnA <lr|rinitr fr««n tbt* (-itjr of Vi««wi» 

|i«/</«»«M I»r V«n llnii**nirv-n. t««tfr««ic at tin* t*nn«*niity iif lihrnt. itirfnl»*r 

•In- h^ 



oC th«* •ti]»'rv<r <<*tii»«'tl «*f |m^»li<- h)in^f»«* I^ l*tttx*'%«. |ir«»ft««aiir at tl»t* I'nivrr 
■itt •»( I.M-ir*- inctiil«*r **t th«* AnivTiiir t<«<st»« tl ••§ |hi14h* liyin«*t»^ 

H*J*f%'t In N»t»4rt4i Kjum. |ir«*fm»c at th«* rnivrrmity «»f Sc Xa^irr. ? 

ii^mm,4$ri iH 11*41. < hif f <if thr •■Jittju'^ «rrvi(^> of thr tit} of ro|«<filym»«. 



ciirvalt«>r 'tf tKr «tr>l«*r **t Ikum^ttr"^ 

.S|*iii. itrtt <'hArt«<« it*rfiM|n«*r ilinr«*ttir *if th«* Ur«iKni|ihiiv] ati«l StAtlMnal 
ltt«tit*it«- of >|«iin 

I Mifr.f sf.ii, • |»r M J H»mmiMi\ i^w wn l a ^i a t u n t •nntriin $u%»\ ttifr^tiif **t th*- 
liyirvffti* UU>r«t«<rf rnttrvl ^itJll«« llAnni- il««i|iit«J .Srrritv 

# r.t«.. t»r jAi-i|ti«^ lk*rtilli<i. rikirf *U ti»r luanii-tnU •CjUMtttal w«*riut for tbr 
rtt% • f P«r\* Uk'tnlarr «*f tb* onwnJttAH o<aailtta« <■/ iwUlr b«ictrt»r«»f Fniiirv. 
BK-ti.ur«.f t)*»* •a|a-rtor i«ittftrtlof Haltrtini. Ilr. I* wituir^l. mvvilM^of tb** 
in»iit«itr <ir-M) •*f tb« Vm-nUf of Mmltt-tftp «il l^n». |«««i4*-tit nl tbi» o«0iiltini( 
r««siuiittr«> 'tf puUtt hririmr of Frvttn*. I)r. y«tli>r. •Mi«-Uitv> pmfwaBC <»f tb^ 
r* «»lt« of ll»«tk-ti»r .tf |*arto. lorttilvr «il tbi* c-uOMtltlntf ci«iiiiitt«v of |MiUll«- 
bytfVtM* t>f KrmtMv 

/l'«M«fi«ro« II |b«irr |Vrt<«'. r«Mnl-#wt >f ml of llf«»ilar»» 

llmn^ir^ iH TtCIirtlW lliyarr. alAU* n^iMrliC rblv# of tbr MMtltATy an-tlotl 
!«• tbr lainutc-r **t tbr intrrv>r <»f lloatfan I^ Abulaf K«»tai'*. amU-r M«*rvtary 
i«» tl«r . rtitrml •tAtuti«^ iHtrNM «if tbr Kin«il«<a til llimirftfir 

/r i/y |»r Ili»*l*-lt4»r l«i«i.ibirf of ibr «lAtl«tli-*i iMinrmn «»f tl»r war ••6k ^ of 
Ihr Ktur^tu ''f ItiJ) Dr X^mim HimutwtU. MSKtalr t«%>ft«fti>r *.f tbr rniv«>r>it% 

i*f M<-lilkr 

If' < t.f l»r iN'fUni* llara \m4wmmf^ of tl^ f* lUtjr .^f in««lu tnr ..f )frti«^* \H 
3* mm- KAiutrvf «uiltAO tnalOTrtt^ rnm'primry t«» tbr MI|«fV« •■JIltAry i^KAtiril «if 
Mrtb.. 

N 'MO* In Kiait* Hani n. pbyalrtaA tn rblrf «if tbr b««»|iltA] ttf llrtg^i 

\,tk*rLf%.l» Mr )frni»ii tlnuuio tn^fiN-ft-r of b%irirnii w*r«v«« xf irtlLajwl 
Mr NaJt«-t i>r^4*mmtt *4 b>tfVt»r -if tiir I'liitrrrtty «>f Am*trnlain 

/^•rf«^i/ IH Frm-lrtt ttr )fallA». jr |if«ffnMif at tbr riii«rr»tt) of « ••iiiil>nr 

\n Jr^i 'It llrllii Vuniia mtmlmtt t»f cbr Ho^al AcwWtuf of i%in»t>pa at Ia«l«iii. 
|»r O.Aitr« l^«|v>bl ttiM Hanb» 

sww'Um -in Wa»rtlMb>. ttfitttwk< til tbr f^*)*! iMnlk «) ai|iulnutrmti*«ci i^f 

>«rif£rrf«tM.I iH Uttlllaiuiv' (timtor taf tbr KMlrral lmr«^ii ««f •talutNs at 
llrftir 

t r«iy«.iy iH tirtirl |S»l|ry ^»trmmm *4 tbr fat olty i»f lMmlklt«r««f )ff4str% lilro. 



68 MARINE-HOSPITAL SERVICK. 

The president presents the iiiternatiouiil cominisKioii the authentic text of tii 
iioiuenclatiire of the causes of death arrange<i hy the said commission. Ti 
noiuenehiture is attached to the present agreement, which the president innte 
the delegates to sign. 

AOREKMENT. 

The delegates agree to recommend to their respective govemments the adopiH 
of the nomenclatures of the causes of death attached to the present a^p^eeineQt.i 
order to insure uniformity and comparability in the statistics of the causes 
death. Ixjgiiming with the 1st of January, 1901, 

They recognize that it is advisable that this nomenclature be revised everr v. 
years, the first reN-ision to take place in the course of the year 1910. Int 
al)seuc^^ of other arrangements, the Government of France is charg^ed to conTOK 
for this purpose and at this date, a meeting of a new international comniissvn. 

Countries that have not taken part in the commission or that have not axo^ 
the present agreement may assent to it if they desire. 

In witness whereof the respective delegates have signed it. 

Done at Paris the 21st August, 1900. 

The delegates from Austria, Belgium, Bolivia. Denmark, Spain, United Sttss 
France, Honduras, Italy, Mexico, Monacro, Norway, Holland, Portugal, Swefe 
Switzerland, and Urugmiy detdare themselves ready to sign this agreement. 

The i)resident quotes from the remarks made by the delegate from the cityr 
Dresden (G^ermany) at the opening session of August 18. 

There are several nomenclatures in use in the statistical bnreans of the Gkrw 
cities. At Dres<len, for example, the monthly statistics are published accoidiv 
to the svstem drawn up by Messrs. Flinzer and Lac*kner at the request of 6 
imion of statisticians of the German cities: the weekly statistics, according t 
that of Virchow: in addition, the city is obliged to make a third tahle. ik 
monthly to satisfy the imi)erial sanitarj- office, and a fourth — annual — fcvlfc 
Metlical Commission of the Kingdom of Saxony (Landes-Medicinal-CoUeginmV 

The simultaneous use, however, of several systems causes no difficulty wb* 
ever. It suffices to submit to a new arrangement the bulletins concencEi 
<liseases whose classification varies for the different systems. It f oUo^ra that ^ 
tistical bureaus can, just as easily as these four different reports are made.ffi 
nish reiK>rts in m^cordance \Nith the Bertillon system, the commendable qiuj^ 
of which the siK^aker recognizes, and this he thinks thev can do without amndv 
ing their present systems of classification, which are indispensable for comptRrt 
with the iMist. 

The international commission accepted these remarks as part of the proceeding 

Tlie president recalls that at the session of the morning of Aug^ust W ^ 
delegiite from Austria made the following remarks: 

**The delegate from Austria states that a new nomenclature of diseases b 
just lxH»n dra>\Ti up in Austria, inspiretl ])y the nomenclatures propoeed ^. 
M. Bertillon. This nomenclatun*, however, has been drawn up especiallT^ 
reference to the statistics of hospitals, and is a little more leng^thy f.hi^-n thit^ 
M. Bertillon. This nomenclature is still only in course of adoption; it will t" 
reviseil in f>'to])Hr or X(»vemlier next. An effort will be made to make it appn«i 
as nearly as iK.)ssible to the nomenclature which the international oonunifliii 
shall adoi>t. but it may i)erhaps be necessary to retain some differences, in oi* 
not t<.» dejMirt X**o far from ancient traditions." 

Tlie international commission accei)te<l these remarks as i)art of the proceedimp 

The delegates from Vienna state that, while signing, they make the follofn^ 
dei'laration: 

** Tlie un<lersigned delegates agree to recommend the adopted nomenclatmtf ii 
the {idministratiou of the city of Vienna, and to do all in their i)ower to have tbf 
adopt e<l by the 1st of January. IIHH, in order x*^ insure the comx>arabilitv of ^ 
mortality statistics from the beginning of the twentieth century. 

•* Dr. Haas. 
*'Mntn'rip(ii Councilor of the City of VieniA 
"Dr. Sedlaczek Etiexxe, 

"Minn'cilHil CoutUeior, 
"'Dinu'tov of thi' Statii<ficoI I>*jHirtw*ut of thv City of Vienntu" 

The intematir)nal commission accepted these remarks as i>art of the proceeding 
The delegate from Denmark states that in signing the agreement he mafceeV 

following declaration: 
•• I vi)ted yesterday ft>r a publication of the protocol of the commission inc* 

fomiity with your p'roiH>sition. * 

J 



IfAEINK'IKMritAI. HKKVtrK. Alt 

Vm UitiAC «nihiinr«M bjr iiir U<*%t'miiit^it I iiin«t tnmkr ihi* rfwrvatiiici tlwl 

•ifc'UAinr** •K'ttiM (■• r^-ir»r«lr«l ftitii|>l> »• m ivtwiuiI aiiwtit 

A* M IVrtiHoii rviiuirk* tti hta nj^irt. ciir R^iyal HAiiitju> i'«mtM-tl «>f iMn- 
ik luMi ti«>f f<r th«* tiMUnt'tit «Un<il to Mxiriit thr |ini|H«ltl<«« «»f M lW*rtin««i 
■• r*«*i«i t*r thu <l«^ iia<<i wan that •mh m rr(*irm wimkl «« rrrtaia |*ittiU dW- 
li tniT vt%ik%*mhMry f«inn«. 

I t-mn *m\t tir«^«^t. ihm. tin* imiCitf^il l«* my <^>Trnuiimt and fur uir |«ut 
««nm«-tii| t«' tiif* U«nl ttf K«^lh in *mT r<*Qtitry (airluU «i>tl atii-vwiitv** rfUtnnm 
|iri<|BaMii'<i<i ii»«lff* mhI ailiifal*^! Inr th»* iAtrnuiti«icuU <^<tiinU«t«iii. 

• K. M Hi.rr 



rh«' iiii'^niAti«ituil « <>tiitiiiiw»<<i ft'i^Pinl clkrw* n-nmrkai^ l«n '^f cht* {tf^vmlinif* 
rhi* 'li-l* trmf' fr»4ii iCtiMU tiiakr« lh«* fi»ll<»wtit|C rrtu«rktt 
Ur^Ti iilix Wt* th«' lillwilAti lih%a|«'UUi«. Alwa%tt r|ii|r«T«tr U* t*«im(»ilr An tmf 
|B«M|K:«t 1)i«- ••|<1<V% til i»rilrr IhAt A |«lli*tli-Al Al**! tnitlftnllJiCr «t»|illt*Alt«*n !•! 

ilt4ir> iiin^atir*"* <-«n ^•*«lniwtifr«4ii IIh* tiif«>nii*fi«tti fiimuhnl hy tiw* •tAlutii*« 

r ff-1><>^-««r) «I ili%-|«l«>ri of tli«* « JillMr« of cl«*«th |*rv^M'tita. It U trtW' th>* lli«'«*fiYrt) 
«^ «>f • hanirr With Ihf )>f««irn«« of aiVtti-r. Imt. on th«< otln-r KaimI. th«* AtiAtom 
1 «lMl»t<'n CAIl tl«* l«itttf«*r \m* ««*n«l«|rr««l AAlllral. tllll*. f<*r rtAtll)iU-. It t«pn*|M«f«l 

rlAM t« tAiiti* Atnont; tlt^ tK-ri«m« diwiMw ■. whtW* In Ku«»Ia. mm tiiorwirrr tht* 

nttiiw)' n luMi Ai«> A«tf|*c«^| It. It u rAnic««l Aioi*fiir ir^nftrnU ilfnAw^ «»ii tht* 

trf KaimI. th»' r«Uti%w •tAlithty iif tli«> •rri«t>i »li>tiCr«| liy tli«* o^tmiUiiiiin <mii 

I n%ftl in Ail%AiiiA4r«*« ttH* •*tii*iii|Oi'Al •Iirui4in mm t*lAU*nit«^l t»> tli^ Kii^lIasi 

ntuiwiiotw 

ri>r intmiAii'inAJ'tiiiiiiiiwi'tci Ai'tv-t't*^! tbt^r r«-tiiArkBA#t«ui tif tlir |«r«B«^tiiiiev 

Hm< •!• |«-kmc«< f r««i hwtt«*>rUii*l •tAt«^ tliAt in •tin>tn«c th«* AKT«^rtu«-tit hr tiuUir* 

• ftill.fwuii; *\rn LAnili<<n 

Th** i|«-}r^Ai«> ••f thip KnU nU < •>fif»ril of SwitJErrUml. hAnniC n^* <«Chrr tiiAtnii'- 
n* fr<>tii hi« <t<>vrrfin>ff*tit thAti th««w* <if tJikinif t«irt tn tb«* o«ifrfrtM-«* AOfl of 
kktntf A r«-|«'rt. wi»b*«. tir%f-rtlM*l«^«*. ti» «!«« Un* tOAt AltHtHUch th«* < UMafti-Atii« 
f-Aa**-* ;ii th« ft tiit-ti. Ut'ir*- n^iiltinif fr««tn th«* «l«»lt)B«rmtititui i« t»ot tliAt whwh 
^r«ivY-:'"<l in "^wittcrUr.'l \t'' mtCtrwm tt* r«^ «*ninirn«l in ht« coitntr} «-% ••rythmic 
Ik h m .'.\ Ut'A t'> r«tAMi*h i<>ni)«irA)il«* ii; >rtAlttir nt^^titttli^. TliU will l«- tli** 

ifV rHM\ f -r hllU 111 ihAl th« IH'W S«1m t»oill^ni Ulurv AlTBIIlCnil fnifu thrrttol«« 

J !• it.t ' f %i«'W will |««nittt of rtviBitw* to tin* «lrtuAii«U of thr thn^ llrrtill««i 
lit**t»' lA!nrw-« 

rikr :?.*« rt.A!)-tiAl « • infia«ii<<n Ai-r«-|4«^| th«-«r rvmArka i^ |«irt «>f thr |inB««r«linirii 
ti « r!i««« «il.*ri^ f t.'tr- 'ttftt-rvti;!***! ttrli <At«« !•• th^ intrfHAtKituil « ••itimtaiBl* ti 
iJnr**) T • r«- 1 '.«• Utf I. >ii|rt»i Uttirv* «>f I A*l«r« i.f i|r«th of I^Afta hA^r •tiflK^I thr 

• ««•*..!.«:• * . «hiih l« Att«to l»r«l An Atlthrbtk* t'«*t>y of thr AirnvlUrtlt AImI thr 

|l»rf» U!?tT« 'f *tir> • AUat"* t.f fInAth 

\'a*!r;A i*\ "t \ if-niAA : ^%^tlM~ark. 
IW Iat^hii. |*ii'/t%« VAn Knnrtttfrti 
|b.l:ti4 \At«>l««'n iLuiA 

Ut.iu^rk y. M iio<r 

>cmiti < art** llArrAi|Qrr 

I i.)tt«l *«f^t»« M J K««wtuiu 

KrAtx* r |lr<>tiAriUl, JAii|t>v« llrrtil|i«ti. Nrtta^. 
ir<ffi«ltirA* li»-^tr«- |Vt t<c 
ll*)i.^'«rt < hvirr Ki'%Ai'A. 
!•«:« U \.\M 1. Mn»ol»rttA 

M' t ■ r inn- I'AfrA Jiw llAt»ir«^ 

II '.a. - i •-tl«;ii*-tt 

S r»j)% K Han— n 

II :.A'/l .1 \|« !»!»•• lfttl<itI«A K ?^tr€ 

I* n .^«: lNlt.;il.|« llAlt.* < Afli»tl.»>WU»t«« J «lr l|rlb» VlAntIA 

*«»««1. t. K. h WA«rtbJk| 

^*«l .*fr r .al.l (flllllAttllir 

I t\i^.*\ Krirt<|ii« |N>ur% 

%•• \i {• f. til thr Au»nl • f thr ICr|H|t4W of IIa tUMW-r Afa«l thr IU|4lli||« of •^J 
lif *- U*' t r« arftt *«;rrrtl»rbt 

«^n.r»>«i in t.'t*fiinuity with th» ort^tAAl 

I* Urn*** Aki'ti 

j4«Vt B^ itCAril J«*% 

.Sfrrrfiiry ««Vnrr«i/ 

\H SrrrCII. Serrwtttrjf 



70 MARINE-HOSPITAL SERVICE. 

APPENDIX I. 

I, the undersigned, Rafael Rodriguez Zambrano, professor of the Central U 
yersity of Ecuador, delegated by the President of Ecuador to the commisi 
charged to revise the nomenclatures of the causes of death, profitin^^ by the I 
clause of the agreement signed at the close of the work of that commiask 
declare, in virtue of the powers vested in me by my Government, that I agree 
the terms of the said agreement. 

Rafabl. Rodrioubz Z 

Pakis, Atiffiust S9, 1900, 



appendix 11. 

Legation op Salvador, 
Paris, September 8, 1900, 

Sir: I have the honor to acknowledge the receipt of your letter dated August < 
in which you were kind enough to inform me that the note inf ormiii^^ you of i 
appointment to represent my Government at the international conuniaBi 
cnarged with the revision of the nomenclature of the causes of death had arriT 
too late, the commission having concluded its work before its reception. 

I regret very much this circumstance, which has deprived me from tkking pf 
in the sessions of the commission, but since its last clause gives me the ri^t 
add Salvador to the States which have already assented to the agreement, I iri 
to avidl myself of it. Consequently, and in accordance with the text of the agn 
ment, which you had the kindness to send to me, I agree to recommend to i 
(Government the nomenclature adopted, and I think that it will take dne note 
this recommendation and of the advantage which will result for statistics fn 
the uniformity in nomenclature. 

Thanking you in advance, etc., 

Rafakl. Zaldivak 

The Secretary-General. 



Report on the Proceedings of the Tenth International Ck>NOBi^ 
Hygiene, held at Vienna, Austria, October 13, 190O. 

By p. A. Surg. M. J. Rosenau. 

Vienna, Austria, October is^ 1900 

Sir: I have the honor to submit herewith a report ui)on the proceeding's of 1 
Tenth International Congress of Hygiene and Demography. 
Respectfully, yours, 

M. J. ROSSKAU, 

Passed Assistant Surgeon, Jtf. Jff". ;S 

Surgeon-General Marine-Hospital Service. 

plague. 

Calmutte read a pai)er on plague, in which he treated the subject mainly hi 
a therapeutical ana prophylactic standpoint. He pointed out clearly the value 
the antipeste serum of Yersin, both in the treatment and prevention of thed 
ease. He also showed the value of the Haffkine prophylactic as a purely prefB 
ive measure. This paper lias been made the subject of a special report. In \ 
discussion which followed it was again empliasized that large doses of the sen 
are necessary in ordtT to effect a cure. Liguere stated that 60 c. c. of the sen 
should be given into a vein a.s soon after the ap])eiirance of the disease as poesBb 
and from 20 to 40 c. c. more should be injected twelve to twenty-four honzs aft 
wards. 

****** n 

The discussion upon the best means of destroying rats on board vessels brooi 
out nothing new. 



VAEIXX-UUttl'lTAL HKEVICK. 71 



Tbr f *« t thm ihr limmm **f uiu^ aihI rmU tna> nktry lb** iIidp^m* mti0 tumtVMMil 

• • • • • • • 

Tlir <Uiutrr **t o<iTr%tii|C ttif««*tn<i« m ini^-luui4lt«- w^ tlkaroMMl pn* mhI t-<«i. 
TW <liAi-nh»i<« iif iliaibfn'tttitf thr ««r««» tif « vrwrl i-aiTrttiic lo.ivi tmui wa* !»■«• 

• • • • • • • 

TIm* antii*! wAn iinjuitti»iHiAly rif fht* iifiitifcitii lluiC all vr«Mrl« fr^itu an tnft^'tMl 
|airt •IvtiM • mrT% m •n|»|>l% ••# aatl|w«iU* Hiniin 

• • • • • • • 

Wurif Att*\ lli<rrar« •Cat«^l chat tbr> futitnl thr t«M tlliu *»t plaicn** alnt* aftrr forty 

tla%» 11. • • «r4trr 

• • • • • • • 

A rr«.!titi'4i W0 immn 1 in tm%**T **1 Knuii^' takinjc tbr itiit»ati%a* tiiwanl « aIIidic 
AAiilltrr :iit«-rtiatit>fial «aiiitar> t^migrrmm in ««r«|rr t«* ail««|it ttitmiati<icial tiir«*urrM 

Till* r«^'Iuti<«ti «*» utt«iitiiii«ti«h |MM— ^i t^iT r%vry\»m\\ im^amt at ihr iiH^titiic 
wfiM^l x-» f ■<« 1 tin •laiitf^-r tiH-tiat i&K tbt- w<irl«l fr^iiu t^H* n«wak*-oini( **t thw 
«liv«ilfiil m trtinr*- 

An tntrrrvtinf; rr|«in n|B«n tht- «atk«i "f rrllt.w fr«rr. hv I^Miat atvl Wnrti. ht^ 
Alr*-aiU U'vn tranftlalnl an*! wnt ttttl**- Ituivan < Si«* I'n^Jit Iffmlth lic|a4'tji.Vtil. 
XV N'-' >^* !^|«trnit«*r T. !!*■• Tli« antlfr* «if thi« r**|*»rt •uiuuiM ii|» thr litrr 
atnrv- ^n iIm* laMiIlua ii tr-riii«lr* anil it* iviati*in \** yrl|4tw fr%rr Tbry <•« mi- lintel 
that thr (t^i lUnm »ttrfii|tlr« iU«i**vrnr*il hj Satiar«*Hi ac«*tii« t«» !■< thr ai^^^Ai* airmt 

tit JUTili'W frtfr 

In a iTv-ni-ral <li«i iiM»i*'n «ihii h fi>U>wr«| n>> tlwwutniic ti|*tni«jfi« wrrv rtjinww il 

MrtiTiirat » 



li"tit t*rr«mtnl a |ai|«*r niaiti ll««*tinnir thr aftinty ••( •rmm*. tn whKh br 

rr%lr«r>l tt.r t«" IHrfh'*!* ! Ill* ''Wn tlirth**!. I«*r«l iit>i*n thr ani<«Qiit «>f 
■rfTim 'iw^tfotKr w«-ii;l:i of ih« ipiitirii |itj( An«l .* thr mrtti**! ••( llrhnnir an«l 
Kl'7l-' h t«^>«1 u\»'i\ fhr •^•i«-iii f iinttA Tttr Uttrr •%tttrni !• n«»w iint^ri^allr 
n«"! ••;•« ial'% •:}••« •h«* tii-'r*- riii. ( ••ti.|>«^ . .f Khrlit h n|a*n t*itiitii ttii •fim «ni| 
li'i tl«« T);««> Atti 1:*^ hA%i- )ir tii(l.^ t.* thr |B«it|t<y iif atititi*sm« a |ir«^-tJia'*ti 
w}.: }. • wv-1* «-tii«*l \*y 1h«- |>h>«i4'ian 

1} *■ !:« ii««i<>ffi f- II 'Wtnic ()*^ ivaihncof tbi« t^«^ t««*iitfht tvtit an altii*«t nnatii 
B» •:.• « ti*r«-wi"fi of •ifitniiin an t«i tbr ^alvirtif «lt|»|itbrfia atttittiiin Ui|h i^ a i nra- 
11% r 4t.l {ir«-«f-nti%«- ni«A*tirr 

\ r«« I'lti'iii ««• itnAtitnpioaljr fi^aml by tbr i««rt|t«i to tbr r||<«*t that tbr n«* 
«^ Ai.tit' t:t. A* A |irr«rnti%«* ha* !>•* tMil rffrv-ta aA*l may ai-v itinpllvh mtii'h ir»«l 



\t. tK«r rv-«*'luii<«i ««• tft*Mv«l th*><iirh n*4 niiantm«'n»lr ti» tbr rfft^-t that a 

• l.t: 1 •(. '*il'l ti'l )■- all>«r«| ti'rrtnm t«* ai-biBU aftrr a cMan •fill |4itbrna nutll tin* 
«ir*il't»t (mi ;IIi •ll^(|M<<ar fr«icn thr thr»«t 

TK« t*- WA> »tiir oli)r«-ii.>fi tit thi* rrwiltit^m t»y FnM>olU*l •<! tin* irripun«l that tlir 
t>«-ff*. r \mf ii:*!* »4urtinir« niuaitM in tbrtbn^l alt iniititba an«l that thr titiir m 
fr4 \< t r*.t«- ti>rrif-r«r a ni<nii0iir«* tif •mh w*Trfity 

TL*- 411 « •hw-ntiftjC iftr mm U* tbr valiir of «ll|ihtbrna aiitil"&tn « atiir fr^ui 
KiiwUi.l whrft- \\ u . lainirvl thr rwitll* bavr bill Ivrti *n fA%<»rak*|r mm rr|Birtf^l 
ritt wttrr*- 

It WA* Bh wn tluii ilir tut*naliiy fn^n •lipbtbma ha* iltiuiniftlinl m aM < ••iintnr* 
«l.»rr th«- aiitttoltn U llw^t 'Pttti Wiw oifublrffvil hy •■cur a* a rv«i|ll «*f thr 
tr*A'n.'t.1 r«{«« lAlh mm thr «ltvAw ha* tvt alMlnl In Kllirlat>«l wbrfr thr aliti 
I* t u trr«tii«« t.t !• ift ivitilAr It «a* artftir-l ••» ihr •■c!»rr Ikati*! ttkAl tltr ill* a»* 
b** «rr« II tiiklt'f iti • hAff* Irr in *.Ur t"^* tr^r^ thrirt|,(h naUtrAJ <*r Uhkn<«ii 
cA'iw* Thr f* I n ntAin* iIiaI it u ii<>« %rr% •liflW ult i*» ••l>tain %trulrnt titjih 

tlwfiA • Mltitffw Aliil At thr l*A*tf-tir Inalltnlr aII«I <4l»rr |>lai rs « hrfr Antltt'tttt l« 

lu*lt- It I.A» T««-ti fiitit»*l ivi««iMr% 1«i tt«r artiAi lal ittrajM t*> Ibi r»ia«r thr %iftiU i>. r 

• if tl^r l:{.htlama i ultufrv tU •«^lrff tii •»Maltl a tiitlU «»f ftuAi Irtit |aiCrU* t t«* \*t^* 

<Sn •■ Atitit*itin 

liA^r* rrri«fftf«t rA|»«-iall% intrrrAtinie r««ult* fr«<u K«i«ituaiiia wbrfr it mrm^um 
ilkt^ithffVa n^ \mm^ r|»l«W-tul( In w*«rrv f**riu In thr vUUirr* whrfr Alttltotlu 
wmm nm^l tbr iW^b rml« «a« Mualt aa»il tbr i|UnM» »•<! «llaa|'|K«f«ii . whtir la 



72 MARINE-HOSPITAL 8EBVICE. 

neighboring villages where the doctors were opposed to the use of antitoxin, the 
death rate was high and the disease assumed epidemic proportions. 

Martin read a paper upon the treatment and prophylaxis of diphtheria and 
pointe<\ out the brilliant results claimed for antitoxin in France. 

During the years 1890 to 1894 there was an average of 1,432 deaths caused bf 
diphtheria each year. The serum treatment began in 1894. For the five foUow* 
ing years, 1895 to 1899, the annual average death rate from this disease has ben 
354. The difference between 1,432 and 354, or 1.078, represents the nnmber of 
children which he claims are annually saved in Paris owing to the treatment. 

Professor Rauchfiiss, of St. Petersburg, made a 8i)ecial study of the importance 
of giving the injection early. He studied, with this ix)int in view, the statistic* 
of 39,000 cases, and found the mortality to be 7.4 per cent when the semm wu 
injected on the first or second day; 16.2 per cent on the third day: 28 per cent 
when given still later. 

Other figures were given to emphasize the importance of giving- the senuD 
early — as soon as possible. 

Another benefit from the use of the serum therapy was found in the greatly 
diminished number of surgical operations, and their greater success "when per- 
formed for diphtheritic complications. Martin concluded bjr stating that after 
five years of trial the serum remains the best treatment for diphtheria. 

Two hundred and thirty-two thousand children have already been treated by it 
Of these, 37,000 died, but more than 60,000 owe their lives to the immortal diacor- 
ery of Behring and to the remarkable work of Roux. 

THE BACTKRIOLOOICAL EXAMINATION OF WATER, 

Fraenkel stated that the bacteriological examination of water has t^wo uses: (1) 
To find pathogenic organisins, especially typhoid and cholera; (2^ to determizK 
by comparative analyses whether a filter or other method for purifying water is 
effective. 

The general sentiment of the section as expressed was that it is almost impos- 
sible to pass judgment upon the potability of a water by chemical and bacterio- 
logical examination. Manv other conditions must be taken into account. 

The bacteriological and chemical laboratory for the examination of water should 
not be bounded by four walls, but should include a study of the source, the water 
shed, and all the conditions that might influence the water. An examination d 
a water made to-day might find a potable liquid, whereas to-morrow it might be 
contaminated with cholera, typhoid, etc. 

Calmette emphasized the point that water should be sterilized before nse— thtf 
is the surest way to prevent the propagation of disease by this medium. 

Sand filters have done much good, but they are not perfect, and may be, or 
often should be, supplemented by a process of sterilization. For this purposely 
esi)ecially recommends ozone. It has been found by the commission, including 
Roux and Calmette, that ozone freshly prepared and added to water will quicldj 
destroy all organism, excepting an occasional subtilis spore. The ozone cuCbo oxi- 
dizes the organic matter and finally disappears, leaving no trace. The metliod. 
therefore, has the a<l vantage over other cnemical methods of purification, thatno 
foreign substance remains in the water. Gaertner expres.sed the opinion that too 
much importance has been attached to the finding of the colon bacillus in • 
water. Such a water is not necessarily nonpotable. He examined the dejedi 
of a menagerie and found the same colon bacillus in the tiger, elephant, ostiidit 
etc, and argue<l that as it is so widespread in nature it is going too far to alwaji 
8usi>ect typhoid l)ecause we find the cohm bacillus. 

The section unanimously passed a resolution to the effect that all govemmenti 
should take steps to prevent the contamination of water courses, both fran 
industrial and other sources, and that si)ecial protecticm should be enforced (o 
prevent the contamination of drinking waters, and any such water that is B» 
l>ecteil or could readily be contaminated should be sterilized, 

TYPHOID. 

Vaillard expressed the opinion that there may be various races of the bacffl^ 
typhosus. He found organisms in water that varied in but one i)articular £nB 
the text-book organism. He used Eisner's medium to isolate the bacillus frai 
water, and found no diflSculty in doing so. Some of these organisms, he stated, d9 
not agglutinate. 
In reply Gruber stated that there may be various races of the typhoid V>a**^ii^ 



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74 MABINE-H08PITAL 8EBVI0E. 

most prominent bacteriologists of the country, showed it to be in any ' 
deficient as a practical laboratory for the purpose intended. 

My duties were such that I was unable to hear many of the papers read, 
therefore can only give a partial report upon the proceedings of the assodatiG 

Several interesting papers were presented upon the baciflus coli commnnis 
variations, significance from a samtary standpoint, etc. 

Major Reed, surgeon, U. S. Army, read an account of the work of the coxninia 
of the U. S. Army detailed to investigate the etiology of yellow fever. His pi 
consisted of two parts. In the one he stated he was unable to find baciUus i 
roides in 18 cases of supposed yellow fever; in the second part he advanced 
theory that the mosquito (especially a species of culex common in Habana) 
the intermediary host of the yellow-fever organism. The evidence upon wl 
he based his clamis was that of 11 nonimmunes bitten by mosanitoes 'which 
previously fed upon yellow-fever patients, two contracted the oisease. Of tl 
two, one alone can be considered as being of any value as evidence in sni>poi 
his claim. 

Dr. Bracken read an interesting paper upon leprosy and recommended thi 
national asylum be established. 

Surgeon Woodward, United States Marine-Hospital Service, read a x>ai)er u 
the foreign work of this Service. 

At the close of the meeting the laboratory was repacked and shipped to 
Bureau. It arrived in good condition. 

Respectfully, Donajj) H. Currde, 

Assistant Surgeon^ M, H. . 

Surobon-Qbneral Marine-Hospital Service. 

Respectfully forwarded. 

H. D. Gki>i>inc»s, 
Passed Assistant Surgeon, M, H. S., Acting ZHredo 



ACCOUNTS. 
VOUCHERS PASSED FOR PAYMENT AND SETTLEMENT. 

During the year approximately 16,588 vouchers were pa438ed bvl 
division for payment or settlement. 
The following is a statement of these vouchers in detail : 

Paid hy Q. A. Bartlett, disbursing clerk 14 

Referred to Auditor for examination and settlement I^^ 

Paid by collector of customs (as special disbursing agent) """ 

Porto Rico, paid by collector of customs (as special disbursing agent) ..II 
Hawaii, paid by collector of customs (as special disbursing agent) HI 

FINANCIAL STATEMENT. 

RECEIPTS AND EXPENDITURES, UNITED STATES MARINE-HOSPITAL. SRBVICK, FOB 

FISCAL YEAR ENDED JUNE 30, 1901. 

The balance of the Marine-Hospital fund available at the commei 
ment of the fiscal year was $773,313.42, and the receipts from 
sources 8960,757.11. The expenditui-es were *1, 007,317. 79. 

Snmnuiry, Marine- Hospitdl fund. 

Balance July 1, 1900 $778,811 

Receipts, tonnage tax 904* (M 

Repayment, care foreign seamen, etc $6,198.60 

Repayment, medical and hospital supplies quarantine sta- 
tions, etc. , and including Cuba, Porto Rico, and Philip- 
pine Islands 50, 512. 38 

M,71i 

Total 1,784,(W< 



IIARtlfS-HUMnTAL HKB%'ICX. 75 



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76 MAKINE-H08P1TAL SERVICE. 

Prevetiting the spread of epidemic diseases, 

Sniiiinary of expenditures, Jtily 1, 1900, to June 30, 1001: 

Balance July 1,1900 $468,581.96 

Repayment, medical and hospital supplies, etc. , including Cuba, 
Porto Rico, and Philippine Islands 6, 233.3S 

Total available .._ 474, SIS.SJ 

Expenditures, July 1, 1900, to June 30, 1901: 

Foreign medical service: Salaries, traveling ezi)enses, 
and miscellaneous _ $46, 732. 85 

Sanitary inspection in United States: Salaries, travel- 
ing expenses, and miscellaneous, including investi- 
gation of plague, San Francisco, Cal. ($15,318.24) . . 38, 279. 01 

Yellow fever: Maintenance of detention camps, etc., 
as precaution against outbreak of yellow fever; 
medical and hospital supplies, salaries, and miscel- 
laneous _ 52,735.46 

Texas border inspection, account yellow fever and 
smallpox in Mexico 12, 178. 41 

Philippme Islands, medical and hospital supplies, dis- 
infecting apparatus, etc. (Marine-Hospital Service to 
be reimbursed) _ 3, 365. 85 

Nome and Egg L^nd, Alaska: Subsistence and miscel- 
laneous supplies, account of smallpox 21, 481 . 42 

Leprosy investigation (act of Congress March 2, 1899) . 1 , 606. 19 

Savannah, Qa. : Rent of station and miscellaneous ... 1 , 057. 58 

Savannah, Qa.: Salaries and miscellaneous, account 
of smallpox 2, 506. 64 

Key West, Fla. : Services of schooner; removal of sta- 
tion . - 360.00 

Total 175,268.41 

Balance 299,561,81 

Appropriation (act March 8, 1901) _ 500, 000. 00 

Total balance July 1, 1901.. _ 799,561.81 

Appropriations for 'marine hospitals, act March 3, 1891, 

Mobile, Ala. , amount of appropriation _ . $i^ 500. 06 

Amount exx)ended l| sooioO 

Appropriations for quarantine stations, act August i, 188S, 

Cape Charles Quarantine: 

Balance July 1, 1900 |8^ 315.48 

Balance July 1, 1901 8, 215! 48 

Chesapeake Bay Quarantine Station, act March J, 1893. 

Balance July 1. 1900 $6,935.00 

Balance July 1 , 1901 6^ 985.00 

Gulf Quarantine Station, acts March ,?, 1S91, August .5, 189^, and August 18 189^, 

Balance July 1 , 1 900 $1 , 347. 57 

Balance July 1 , 1901 1, 847.57 

South Athintic Quarantine Station, act March, 1895 {alteration to steamer tat 

hospital barge). 

Balance July 1, 1900 $1,000.00 

Balanci^ July 1. 1901 1^ 000.00 



MAMlNX-U<H«riT.M. ?»KilVI<*K. 77 

luuii*^- Jui> 1 linn iIta 



|lr«fiinr«#^ «Mt . yiMff^inliMr XftirNf*. cir# Jmnr It, /.«'«»■ 

lUUti •■ Jtih 1 11«i»t 310 19 

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IU1aii'« .IiiU 1 \W* |I'J7.M 

IUl«t»« .ttiU t lVi*l 177. M 

l|»|»ri»|tr»ii I ••#!•• <i»r •/•■«ir«a«fiM# aitit •mm. art l|«ffn*A :. /*••'♦. 

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l\ i*Uti'l yiuinintinr 

lUUn. • Jitljr I IWa* 

lUUrH • .f nly 1 IfiM ' %7 

lUUif • .ltil% I. ll^ai $r»l..CI 

««TiIf yiijirantttK' Stati^m 

lUUiii«-Jnl> 1 twa* |I9. tC? SO 

Kt|a'ti<l««l !•• Juii*- •• 11011 IV. m 14 






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lUUif* .ItiU 1 »•#•! .T7i. 7ii 



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• « 



lu^At.. « j>i:% 1 i\»** $j III 

iuui* f Ju:« 1 i!^*: J III 

lUUt> • .f'lh 1 1 10*1 HVI ITi 

/«r/'iinirr llnriilnr^if* r yMtartiMfiHr .Hfulifm. «ir* Jmi^ /. /« •• 

lUlai. « JtiU 1 11*«i II* •>.% 

lU^*. « Juh 1 11li»t U* .•% 

IUIai. • JuU 1 :Vi*l 1*, III 

lu:«i^ •- JhU 1 lUiii •.* i»i 

lUUi»r JuJy I inui M'l 7« 



78 MARINE-HOSPITAL SERVICE. 

Astoria^ Greg,, Quarantine Station, act July 1, 1898, 

Balance July 1, 1900 %i 

Balance July 1, 1901 4 

San Francisco quarantine, fumigating steamer. 

Balance Jnlyl, 1900 $l,01i 

Balance July 1, 1901 1,01< 

Key West quarantine, disinfecting machinery. 

Balance Jnlyl, 1900 $90 

Balance Jnlyl, 1901 90 

Appropriations, act June 6, 1900, 

Marine hospitals (amounts transferred to Supervising Architect): 

Cley eland, Ohio $5,00 

Boston, Mass 4,50 

Detroit, Mich 3,00 

Mobile, Ala 2,50 

San Francisco, Cal 8,00 

St. Lonis, Mo.- 1,00 

Quarantine stations, act June^ 6', 1900 (amounts transferred to Supervi 

Architect). 

Reedy Island quarantine — $8, 00 

Delaware Breakwater 7, 25 

Cape Charles, Va 1, 25i 

Brunswick, Ga 20, 00 

Gulf 7,15 

South Atlantic 8, 00 

San Diego, Cal.. 28,75 

San Francisco, Cal 181, 70 

Key West and Mullet Key, act June 6, 1900. 

Amount of appropriation . $125, 00 

Amount transferred to Supervising Architect 50, OO 

Balance July 1, 1901 75,00 

Savannah, Oa,, act June 6, 1900. 

Amount of appropriation $80, 00 

Amount transierred to Supervising Architect $9, 500. 00 

Amount expended for stanon, etc 20, 217. 80 

29, 71 

Balance July 1, 1901 ^ 

Washington, D. C. (laboratory building). 

Amount of appropriation $85^ (^ 

Transferred to Supervising Architect $34, 925. 00 

Expended for plans, etc 75. 00 

85,00( 



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/ .••«■• I Mttt'Ar*! amffilifvi/ '*fifmt% iimtl ••rli««^ •tsmAtt-i*'t t«fi/»*-it« f S If irit|#^ 
If •»g»*t*ti S^r' f'r 

\ •« af«- hrrrlty •Iirrrtr«l !•• <*l«rf «r |Im* fiill<>« tii|( nilfv kit ft'ifar*! !•• flir fr«-«l 
U4*-f.t f tt«fn tnl Want* 

\% Lrtjrwff a i^liriii anffrnnf fT*4n a «*4nnintii<al>U* ili«r««r Ium t«^ii nmlrr 
fr«-«tt«*irf»i It) any war«l «tr <4hrr |virtl'«ti fi a ritiCnl ^alra luarinr h>a»pitAl i^r iii 
ar. « w Af •! "f a |>ffl«al«- *tf UiUUhi I|m1 lM»|illai ikm^I rt* hiaMrU f**r llr- trnatliM-ttl of 
|«i*^fila •»! IhU ?%rrvhr It ahall Ir thr ilut^ *tt thr Umllt-aJ «4lk(rff III • Ikmt^r tlarrriif 
|#^ . aOM aatil »nrU vf niiMtnMliI Um tj» ilMnfaLlml aa »ji4i a* |irat tk alilr aftrr thr 



80 



MARINE-HOSPITAL SERVICE. 



recoverj', death, or removal of the x)atieiit; the method of disinfection most snit- 
able in each case to be determined at the discretion of the medical officer. 

Tubercle of the Inngs shall be regarded as a commnnicable disease ^within the 
meaning of this letter, and whenever it becomes necessary for patieiits snffeiing 
from the above-named disease to occupy a hospital ward for an indefinite period. 
said ward shall be disinfected at least once a month. 
Please acknowledge receipt of this letter. 

Walter Wyman, 
Surgeon-Oeneral y M. H. S. 



Circular Letter— Treatisk on Military Hygiene to be Purnishjed 

Officebs. 

To commissioned m,edical officers, U, S. Marine-Hospital Service: 

You are informed that a work on the Theory and Practice of Military Hygiene, 
by Edward L. Munson, M. D., will be furnished to the regular reUef and qnar- 
antine stations of the Service, which are under the command of commiasioDed 
officers. As the subjects discussed in this treatise, especially the sections deal- 
ing with general hygiene, physical examinations, management and sanitatiofi 
of hospitals and ciunps, food and water supply, disinfection, etc., have a direct 
bearing upon the work of the Service, medical officers appearing for examinatioi 
prelimmary to promotion may exx)ect to be examined on the topics discussed 
therein. Medical officers not attached to regular stations may obtain this work 
on special requisition. 

You are directed to acknowledge the receipt of this letter. 

Walter Wyman, 
Surgeon-General J M, H. S. 



IHVISKJN ()K MARINE HOSPITALS AND RELIEF. 



.v%l4A Jil •. 



HI 



ftirOBT OP DimiOI OP MMMIME HOtPITAU AMD ULBP. 



llin .Srr\ii*ff* ownn and o|irnit«^ :?! marint* hiMpitaU. and o|irnitni :? 
AfMitioiiAl htmpitaU in lf*aiir«l liiiil«liii|CK(Nrw York, N. Y.,aiHl I>uU*h 
llarliitr. AlankA) Tbrrt* arr, in a«ltlitiun, ll.*> fvli«*f Mationn when* 
paiitMit^ riN'rivr ln«atot««nt 

fATHtVTH TKKATEO. 

I>iirini: th«« \4*ar .Vh,:ih| imtirntA wt*n* tn*at«««l liy thm S«*rvii*«*: 
il<«|4tal i^iirtitji 13. Ml 

Vmr^ h.»t«(Al r^lwt fnm^h^ Mi. fH4 

ill! T<» trrilKK HKKV|r»% 

Ik* t # rii4# ( *!«//# r .s;^ rfi#'» iMirini; tlir \«*ar 1*3:! a|»|ilH*ant#« f«»r «*nlijit- 
nirnt iitTi* «*tanitn«<<l; 777 |iii.i«(M^I, an<l l.V'i mrr%* n'j«*ot«l fi»r |ih>'^iral 

.Sf#itpri/»««i/ /ri.«; »«-/•« fM Nvrt'iff Iiunnj; tin* yf*ar 1.«>II piliili* m«Tr 
f\Aniiii«*«l ai« t«i thrir VMual ra|iiii*ity Of ihiii nunilMT. l,Vi<* mvr%* 
|iAMM<i|. An«l *.*l n*j«>4*tr<l iin a<*<*«Mint of \miial «lrfr<*tji. 

/,if# .S.I I in*; .Srr »■!#>,- 'nM*n« ii««n* ftaminrtl diirini; tht« \t^r I.IIA 
kr««|M-r<« aimI i»iirfnit*n. of nhoni *«1 ii«*n* rrj^rtnl aA |ih>i%irall\ until !«» 
|H*rfi>riii thf< «liitt«fi rv«|uirwl 

/.I'/^f //*"<«* .Srrr-t«» IVn a|ipli«*aotji for ap|Miintni<*nl in thij%Srr%'- 
Irv* urn* filnnioallv r\auiiur«l durinit thr yrar. Of UiU nunlirr, :i 

c'.^M'.ffi*/ iiw*miwi%» Surt*y Iiuritti; tht* Am*al ynar :m> appliranta 
for ••nIi«tUH*nt in thm Sfr\'iCf wrrt* f*\aniiur<l Of thiM nunilMT, *.• 
«fr«« n'j«<«*l«^l aA ph\<»ii*ally unAt. 

.\ It */ /V|«irfirirfi/. Twrnty-four applirantfi for inniUonn i»n navy 
c^vllttTH nrfv ph>ifrirany rtatninril durinic thf y»«r an«l 1 rrjfN*tr>«l 

i^HKH KXAM1NATI«IN<%. 

'1 «f<tit> -tuo Applii^anU f«»r ap|M)intoirnt an htMpital larwani in th«* 
Martiir |f«M»pital >fr\ i«^ mrrr> phyiii<*aUy ftauiinr«l ami 1 n*j«^rttNl 

l»iirin|f thff* >i*jir ll<» infnJiant M-auirn nrrv t* tainin««4l a* t«» tht«ir 
ph>«t<*al ntiit^fen for «ra <liil> 

SK^ HKIJKr fTTATItiKH. 



lirhrf •lalMin* of thf« MN^vnil rlaMi lia%r lv«*n r«itahliahr«l durinic thr 
yrar at Iht* porlJi of ll«molulu, llawatl, San Jtian, I* U . an*! 





Hh WftOlrAt. 






•• b '• 




84 MABIKE-HOSFITAL SEBVICE. 

SEAMEN E>rPLOYED ON NAVY COLLIERS. ENTITLED TO RELIEF. 

Under a decision rendered by the Assistant Comptroller of \ 
Treasun*, as set forth in the following correspondence, sean 
employed on navy colliers are entitled to the benefits of the Marii 
Hospital Service : 

Department of the Navy, Bureau of NTavioatiok, 

Washington, D. C, J^une £4, 1901 

Sir: The Bureau forwards herewith a telegram signed ** Thompson,'* pren 
ahly from Theodore S. Thompson, pay inspector, U. S. Navy, in charge of! 
Navypay office at San Francisco, Cal. 

2. Tiie circamstauces in this case are as follows: Albert Hilton, "while seni 
as third officer of the navy collier Nero, was injured in the perf ormanoe of 1 
duties on board the Nero at sea, and ux)on her arrival at Norfolk was transfeo 
to the marine hospital at that port and was treated there np to the time of! 
discharge, when the Bureau settled with him by paying him an additional o 
month's pay and transferring him back to San Francisco, the port of his eoli 
ment. At this time Hilton was told to visit the surgeon in charge at the ha 
quarters of the Marine-Hospital Service at Washington and ascertain -whether 
could not receive further treatment at the marine hospital in San Francisco up 
his arrival there, and if he was informed that such treatment could not be mxp 
to return to this Bureau, where his case would be given further consideratioo. 

3. Upon his arrival in San Francisco he informed the Bureau of Navigatic 
Navy Department, that he would not he received in the marine hospital at S 
Francisco excepting by application from this Bureau, whereupon a reprsflentao 
of this Bureau interviewed Surgeon Williams, of the Marine-Hospital Seni 
and upon recommendation of Surgeon Williams the Bureau wired tne BomoB 
charge marine hospital, San Francisco, as follows: '"Albert Hilton "was ugv 
while serving as third officer aboard collier Nero, and was treated in marine h 
pital, Norfolk. Consider him eligible now for treatment marine hospital:**! 
to Albert Hilton as follows: * 'Apply surgeon marine hospital for treatment:**! 
received to-day the inclosed telegram, signed *' Thompson." 

4. The Bureau incloses a copy of the decision of the Comptroller of the Ti« 
ury Department in which it will be seen that the Comptroller holds thitt 
seamen serving on the navy colliers axe entitled to all the benefits aocorded 
American seamen in the merchant-marine service, and it is this Bnrean^s c^ 
that Hilton is entitled to treatment in the marine hospital at San Fraaciaoo na^ 
regulations for the U. S. Marine-Hospital Ser\ice. 

5. If you concur in this opinion, the Bureau will thank you if you 'will )dd 
wire the surgeon in charge marine hospital at San Francisco to admit HUtoal 
further treatment. 

6. There is no appropriation for the Navy to which treatment of this maneoi 
l>e charged, as he is not an enlisted man in the Navy, but a discharged msrck 
seaman. 

Respectfully, Wm. S. Gowud, 

Acting Chief of Buntt> 

SURGKON-QKNKRAIi MaRINE-HoSPITAL SERVICE. 

[IncloBuroH.— Telogram . ] 

San Fkan(;isc(), Cal., ^une 2S^ 1901 

Navigation, N(wy Department, Washington, D. C. 

Referring Bureau's telegrams to Al)x»rt Hilton, late Nero, and marine luMfi 
surgerm hospital demands formal application from Bureau for Hilton's admitttf 
and guaranty of expenses. Please answer to hospital. 

THOMPStf 



Treasury Depahtmsnt, 
Officje of Comptroller of the Tbsasi] 

Washington^ Junm] 
Sir: I have, by your reference, the pai)er8 relatinir to 
covering cost of transportation from London, 
one month 's additional wages, of Adolph '. ^ 
Nero. You desire my decision as to wb 
charge against the Navy Departn 




1IAKl!(K-Ui>;<ri1AI. -KKVItK. 



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ft» «i ^riAf Ala*l ll*r « aIut ff Ihr arr^ It ■*« fff-|i*lt r««i A* i r.l.t? ^« •'.'•< I ;• r • : • . .i.l.><l 

Itt iLr •!«« IaI « bi irf I'f iIm- «iiff|i •l"l»r aI lliia >!• (- ' I- n • • : . .1^ % • • •■ f> 1 
wiii««AiMf»ik«iM irti iulAii«liiiU-rr«it^l«Mi-r«!. . l: r ..- : .1 

i^#«tl fijf lAlall <^ VkiUA Am Ai )r«f la • |; Lft:!."l l<t "-< 

- Amnm^ tW inn *^ «t«ffliii«tf f^n t- ^i ti... i> ;* • (..••i i.< 

■mimIhmi ^r 




86 MABIKE-H08PITAL SERVICE. 

FINANCIAL STATEMENT. 

Daring the past fiscal year the total amount of bills rendered for ezpenM 
incurred by this depot is $161,737.28, as compared with the record of the prevMn 
year, $176,409.79. The expenditures of the past fiscal year have been divided ioti 
classes as follows: 

Bilh passed for supplies. 

Dry goods, etc .' $d4,246.« 

Carpets 2,91M 

Equipment, purveying depot 35S.9 

Surgical instruments and appliances. . _ 10, 8W.i5 

Microscopical, bacteriological, and photographic supplies _ 2, 711 fi 

Rubber goods 2,456.tt 

Beds and bedding... _.. 8,«48.S 

Bottles 1,427.S 

Toilet and wrapping x)aper l,436.iB 

Wines and liquors _ _ 8, 104.^ 

Flags 1,»4.K 

Aseptic hospital furniture, etc 5, 997.35 

Hospital stores . _ 12, 685.* 

Books and journals 8, 574. W 

Miscellaneous articles, pharmacal implements, etc 2, 097.84 

Disinfectants _ 18,701tS 

Operating expenses depot, rent, telephone, fuel, light, cartage, etc 10,843.tt 

Chemical glassware and apx)aratus _ 649.^ 

Station equipment 28, 584.il 

Medical supplies 24, 641.fl 

Total 161,757.* 



The above does not seem to call for any comment beyond stating that if 
parison be made with similar table of the previous fiscal year it will show hod 
increases and decreases in certain lines of purchases, which are explained by th 
fact that the necessities of the Service vary in particular things from year to yctf 

REIMBURSEMENTS. 

The following is a summary of the purchases made for various branches of tii 
Government service, and for the operations conducted by the ICarine-Hospiti 
Service in Cuba and the Philippine Islands. No separate statement is lendoti 
for Porto Rico and Hawaii, which are now a part of the territory of the Uiiitv 
States. Last year the total amount of reimbursements was $28,876.08, -which, i 
I then stated, was "" largely in excess of all my expectations on this subject'/* bo 
it will be noted that this year the amount has doubled, by which the net e^Mndi 
tures chargeable to the marine-hospital fund are reduced to $131,608.68, a soi 
within a few thousand dollars of the net amount expended during the pxeyioi 
fiscal year. 

Reimhursement for »u]}j)lies issued to other branches of the Shrvice und a^ 

services. 

Immigration Service _ $5, 364.1 

Treasury Department - . .._ * 50.9 

Coast and Geodetic Survey X, 721.6 

Island of Cuba Is! 794.9 

Philippine Islands 9' 547.7 

Epidemic fund 7^ 738.2 

Quarantine fund _ 18| 888.5 

56,684.8 



Net exi)enditur€*H marine-hospital fund _ 105^ 118.1 

Salaries 15*890.1 

Commutation 60O.0 



Grand total 121,608.1 

The net value of the stock on hand at the close of the fiscal year ended Jmia U 
1901, was $58,455.05. 



MARIUK'UtNimAL HSBVICB. 87 



iMitniR«i«. 




TW UiIjU ofittmt fri<ii Ihu iW^fBit bMi mrn— iil ovftr tbat of |Im> nrpvlf«OB tbrml 
■hi|i|w<il Thi» fiiUcfiniiir tiftlilr girrm m <lHalM muammfj ui thi* w«iHi i|tici«* 



trail. MAtl«4ia 37 

|HUl •latiotui Aril. amiAil. third, mtml fimrlh rhum ftdft 

iMtnUcrtttiofi ?Vr«ii«* 10 

O^ AImI I »r«flt«*tta- Hanrr)r t 

yillf«l liy ltai>«a • vM^'tor i «iT 

Wl 

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I ha«r ihfl* l^«iir !•! OMik* ihp fi4li»vtaf rpt"«t ul thr ttfrrat^iiM «■# tha Hrr^li** at 
Uub •taii*<i r^* thr ftaral j^mf rwlMl Jnaa B>, IVDl || to iiii—iry f«ic myt\%mt 
w mtmtxxmiv^m *4 Um* mbtart III larloiW BiaiMlr* <if th«* fkna. amrvlra. rU- . fi^r thr 



tttaltiO iif Um* mbjart hi larloiW alalMlr* <■# tb«* fkna. ffmrvlra. rU- . ft thr 
iaa»4i if ivu! ibstaai uf fitf* Ihv flaral yi«r. 

|faiii)«>r "f t«M« iiiwlrr tf«iatinrtil JnXy I. liU» 17 

|fatt>)a-r ''f • mmm aditiittml tluniMr Ibr ynar 1««% 

< nr««1 1 .' 

li<i|in>«««l 4J 

tll«*l 1- 

7^ 

t ik«Wff trvtttMN^t Jaiv » mil 74 

C>^r« ««4u|Jk>aC«l with s^iibllta •'! 

O^ (««i|aii«iMl viih malarto '-*3 



X * 



^H 



MAROrE-HOSPITAL SERVICE. 



^A \tJz 47 <:9^ip^i^ ToAf-T treatment Jnly 1. I9i)l. 12 were gpood 
\ K 'wt<r«'. t^r fjui0^, on sUimuifdon. 21 were bad csaesi on admiasion 
Th^iir ^ixj^ndtv/D wa« aa follows: 

Cnr^ . . 

Imyrffv^A . . . . . 

S*A. itn\frffvtrf\ 

In^ 



on aM^miari 



iUftttsgitiinff Jnn^ iif), 19^)1 



Total 

(!hSkTw:U^ of 105 t-nhtm a^lmitted: 

(hMf*} 

lisu\ 

Tli^fir 'liHii^^mti^/ii waH an follows: , 

LHfv;liarg^rl; 

( *nre*l 

Iriilirovf^l 

N'it improvwl 

UtH\ 



T<ital r#finaininK Jmii; IJ<I, 1901 

Total 

Rkport of Fatal Casks. 



j lion of 

miH- 
Hlon. 

Fair 



Pr<»viouif 
(larat.ion 

of (liM*fiWV 



C%jmpli<*a- 

tiODH. 



Canfleof 
death. 




Ifoliii . . 



45 



I'ottinMiii. I W 
Toblii .. <«i 

pi*t4<rM«)ti, A ' lift 



4 /("ftrM . . Malaria j Tuberrulosis 



OfMMl. 



Fair 



2 II umtlm. Malaria. Hvph- Acute ne- 



rt iiumthH. 



(}<nk1 . Si iiiontlm. 



iliH, acuio 
nophritis. 
Mtmlngitis. 



phritis. 



Tul>ercular 
menini<itiH. 
Oarfinonia. . Cartrinoma. . 



Knlllim . 
Tnu'y 



:r> 



9m I 



liiul 

do 
do 



I y«»ar 



9 iiionthH Ht'niorrhaKo.i Pulmonary i 

I I homorrhaKe. 

j; yiMirM . Malaria i Tuberculosis. ! 



Pulmonary and in- 
testinal tuberca- 
losis. 

Lungs cored, con- 
gested kidneys, 
gumma ta. 

TubercnlosiB of 
lungs and brain. 

Carcinoma of liver 
I and stomacb, 
lungs healed. 
Tul)erculoHi8. ' Pulmonary and in- 
testinal tnberca- 
losis. 

Lungs healln^r 



I 



McLatitrhllii :fti do 

I I 



\\\ niontliH Sypliilis, hh 






.do 



('onri)y ... ifti | do ! l:iinonths Svphilis do 

' ■ I ' I 
lUnknmii ' (ft | ilo : 4 inoiitliH Maliiriu, lur- do 



Flynn 



A)* do I 21 niontliH 



y n X i n 
volvod. 

...do... 

...do... 



.do.... 
.do.... 



('uniiiiinKH '*» do. I II ynirn . 

I I 
Vhuii 4:I I .tlo . 14 niontliH SyphiliH '.i do 

!Iuli*tt ?.ll do 7 niontliH Malaria, lar- do 

' , I y n X i n ■ ' 

' ! volvod. I 

WilMin J5> ' ilo 4 niontliH Syphilin do 



ptrliy IW tlo 7 niontliH. 

iiuinii \t\ .do j ...d«) ... 



Malaria ...' do 

dt> ' do 



Pulmonary and in- 
testinal tubercu- 
losis. 

Amyloid of intes- 
tines and pnlmo- 
nai*y tubercnlosis. 

Adrenal tuberculo- 
sis. 

Tuberculosis of lar- 
ynx. 

do 

Pulmonary and liu^- 
yngeal tuberon- 
losis. 

Intestinal tubercn- 
losis. 

IntoHtinal and lar- 
yngeal tubercn- 

klSLS. 

Intestinal tubercn- 
losis. 

Pulmonary tuber- 
culosis. 
do 



MAKlNK-HUHflTAl. HKKVirK. R9 



T*>tAl nntnlrr **f falal t a^m. IT. ^f whia-h !*• w«-r«* i'«iaitili«'al#<il with imr nr niiirv* 



MaUra 9 

LAryrmptu 4 

fVinifKiciui 1 

AnaU* iir|ihnti« I 



liii I'l'l'ol tn ih«' IiKaI fata] i-«m« thrrr u I fr*in rmtu^r mtmX I fri4ii artiUtiiriilirl' 

||m lli tl.t^' • A^r» th«< ItItU** Vkt'fv* fiintltl !•• In- priM-tlc-Ally b«Alr«l At ttl** im*ni|Mtiw. 

iif tit*' • A**"* «lt* liArtTt-tl iiii|«r**%«'<l % !■« Aiuf 'rtirHil ' v rn m^m whilr rtii|U«*im| an 
atU-fMlat.tA Att*fiti><i u itivttnl 1** llif UrK** tir»|Mirt)i»ii **f \wk»\ rm/mm. mmI 
rwtilu tiiM«f )•• jii>li;ritl «ktih tliu f»-i in vw-v 

Th«* f<-'>' *^it'iS *r«' « Iaa««*I •• " )«il <'Am« til thi* rr|»i|i 

i|i T>i "w IV. frht> h tht-i^' i« tutu h Iuhk ti«Aiif itivttht^l Aiipritiitujil**!) 1wi»- 
Ihinl* t* ••!*•* •ri'tr>- lutitf '-r i% • ••ti«ii|<'m)ilt |«<rti<>ii ••(«*«• h Uiun 

• .* TK «i* :ti wKti h tlt«r< 1" tn«'4%» t]i«*tit <«f '^llirr tiwtii-« ihjiti t)»r> lttnic« itr in 

3 Th «M- tft whi« h itttT** I* • vnlciH •• t*f ni|ii*l jmUaih •*itiriit **t th«« tols'n-nlAr 
pria«-wi irr»«j»* tnt* nf rif^-nt ^f ti«»ni* in«<Unl 

TIk* I «w4 •••iiit-!i' ^ti'^l mtli "%|i)iili« A« A nil*- run • f«\«ir«)il«* t tinr«r. whll** IImmp 
KaTtn^r iiiJiUirm 'l** u*A All %)%•• •>|ihi)itii* i awr^ « ••ntni4-t«'«l tlu»t <li«raiir lapi^ir 
mtU l»-f<-r** itit«-ri ul'Wi* aii«l tin* < ^'iiittlK Afi<*n a|>t"*«r" t«> !<• M*m«*«bat !«• th«* 
|mtt«-iit«' a*batita«^ Malan* -n ttn <*'i;trar%' ••n-rt* a tian«<fnl inftnrtirr vbm 
i-*4ii|>hi «tttia( tiiU r> nl<«t« 

K«rr> 'ff -rt lu%« U'«ri tna*l" t<* |»r« ^•■nt inf«^-ti«ti ^f ihi* •tali«w. Imt In »pi1«* iif 
tb^ ni «t « Arn««t r«'|>r«-«'t.tati«f)« «<f tin- •taiiift r of th** tiiHi-ti**-. Mittn* |mti«^1« frill 
•|*it "ti t^M* tfr«'tiii'l •iirrt jtf :ti.»tulv All •uih •i'«itnm iia« Iwn whm ih«i^»%rfvi|. 
rar» f ■;ii\ il^vtr^'^'^! an<l fiti^IU th*- |Mti«f)U «• n* ntu«t«'r««l anil mfxraii**! in ili«* 
Bi.«t •ikj'La!: l^fiiniA*:*- \).A\ aii%>t:' I •<i.«i< t«-«l • f *|iittini{ An>«ih«'r«* • ii-rpt in 
hi* •|*(i!-iiti • ii|t ii'*tiM \m u.miAU^\\ •l:*iiii"M«l Thi« nilr lia* att|MArvntl> IunI thf* 
i|r«ir««l *ff*^t aimI tiM'r** lui%«* l«^ n tfi kn<<wTi tnfr* ti<*n« KcwruiJv'nnir that 
ttuks*y • f il<«* |*ii* titA ailnnti*«t t** tht« AaiiAtcnQm an' i«ni*>nint ami ilt» niit n**iltly 
$[rw»\* th«* i'l«>A xf •laiitfrr 111 tht* • •»nitn'ii |ini4-tt«-«' «>f •|iitiinir At will wtthi*Qt r»*irAnl 
ii* till.*- • '.A* • of < iri iim*taii< •*. tt •■'•in* a<l«i^«Mf !•» iiiakt* olwlt^ni** tii nanitary 
ml» • A* •■^•\ mm |»«MiMt- I Ua\*' tln-n-f'-n* t.» r«<«^>tnni«-n«l tln^ fniir*« ili«i-i>titinn 
at>v ■ f •K«> ttw ..f til*' ni»-tal ^r **ih*T •{•'it'im *n\» r^inmuig ttt^-ani «li*inf*^-ti«4i 
an*! ^h«- •■;)ii»titnti.«n *>( • m|m l»ilh |p- k«'t ANil lv<i|«i«lr. niA«l«* '^f |M|«*r **r *i(hrr 
maurvAl 'a«t*7 'U^tnii tiM«* li> flrv lh«tnf«^ turn **i •imtoni \*y Mf-ain t« X^Ah 
rt|«'rji«t««* Arnl •«(ffn«Uf ^H i-wttirw atratn «li«inff« turn f«ir ImMlnic. H*- nm«t 
i«iffitin-if- t*' t»* rnii^lii^nl KfTxrt i* !■ inj; matlf t«» (Ir^tMf a pHM'tit-al tk«tnartll4r 
|*» k«t ti|. '.f wbii h Utf*r rr|»»rt wtU tv iua*W- 

« ftfra <•( ffi ) t'kt* iKHii«Ari<>^ i*m iiu* 

TK«- Urir«- rwn«Hr u fr«l !•%■ iHti-h N<i l -i mtl«^ ItiCijr Mo* h UUir i« nn^w- 
■Af^ t«< kr<r|i ihu •lit«-h tn ••nl<-r Imt thu t« * hraia-r than |rtinitiinir ami lh«* wat«*r. 
«ht> fnn.|>i<-nth iiiTiiWU i« ^*t\rt ihaii th«* ««*ll watrr •ti|f|i|t«-«| lt% th«' tf^aUinf 

!»:!* i.<- S M .* Atfl i »ri|>|.l\ WAti^ fur irrtifaiiiiar (If iranirn* ati'l fant* r« •!■<«- 
ll«rS riir^w •l;t« h«^ rr«|tiirv U w i aff tliati %'•• 1 Itu! aII thr •lit* Imw iir«^l « xUu 
■l«r trrl^ullfii; An<l th«< ttaiu f-if iHta b Nn l tuu«t t«* rt>lfuilt |jrf«>rr urtt ai'miic 

act^inr **t i ^aii 

l^u r At.t w*^! M'>V '^ 

|*r- •!•». *• f fAfUi 

'.'. ■ u* ■«! luiv %aJimlal t3t |t. »■* «»• 

t:-M.>«»* AlfAlfa bA9 «altic^l At |t\ "Wi l.:ik\«ai 

I ."• ^'tAttbrU •••ni « Aidant At T% *«-nt« wi T% 

;% Mm .t'fU f>-litrr %Ali|r<l At fH Vi P*: 'rf* 

t i««* '-•.% 

*•!«"«» iiii( |if«int 'tf t •»'-'*v v. 



90 MA BINE-HOSPITAL SERVICE. 

REPORT OF GARDEN. 

The garden has produced the following: 

Beans, string, 269 pounds, at Scents $8.07 

Beans, dry, 275 pounds, at 5^ cents 15.12 

Beets, 1 ,166 pounds, at 2i cents _ 21>.15 

Cabbage, 9,604 pounds, at 3 cents 288. 12 

Cauliflower, 58 pounds, at 5 cents _ 2.90 

Cantaloupes, 1 ,395 i)ounds, at 2 cents 27.fiO 

Celery, 955 pounds, at 2 cents _ 19. 10 

Cucumlwrs, 8,312 pounds, at 1 cent 83. 12 

Lettuce, 430 pounds, at 5 cents 21.50 

Watermelons, 10,275 X)ounds, at 1 cent 108. 73 

Okra, 96 pounds, at 10 cents 9.00 

Onions, 2,517 pounds, at 4 cents 100.08 

Pease, g^reen, 522 pounds, at 6 cents 81.S2 

Radishes, 866 pounds, at 3 cents 25.90 

Rhubarb, 20 i)ounds, at 10 cents 2.00 

Squashes, 5,845 pounds, at 2 cents 116.00 

Tomatoes, 830 pounds, at 5 cents 41.50 

Turnips, 9,784 pounds, at 1 cent 97.S4 

Parsmps, 900 pounds, at 3 cents 27.00 

Com fodder, 8 tons, at $15 _. 120.00 

Hay, 75 pounds .50 

Bean straw, 595 x>ounds 4.00 

Pea-vine hay, 60 poimds .5D 

Com, sweet, 8,326 ears, at 1 c«nt 88.91 

1,250.91 
Cost of garden (labor and seed) _ S90.91 

Showing profit for garden of 726,80 

REPORT OP DAIRY. 

The dairy herd now (November 30) consists of 46 Jersey cows, 1 Hdlatein cow. 
4 Jersey bulls, and 13 heifer yearlings and calves. Nine Jersey steers (yearlings) 
and 1 Holstein steer are being fattened for beef. Twenty-six of these oows and 
3 bulls were purchased in January, 1901. 

The product of milk for the fiscal year was 13.245 gallons and the coet of pro- 
duction 21 ^ cents x>^r gallon. The market price of miDc in this locality is 40 oenti 
])er gallon and the supply is very limited, so that the maintenance of a dairy is ao 
absolute necessity as well as economical. lu addition to the milk the dairy is now 
producing a jwrtion of the butter supply (75 pounds in November, 1901). Tin 
last cows purchased were not of high grade and did not add so largely to the piflfc 
supply a.s had been expected, but there seems no probability that farther {Mff* 
chases of milk cattle will become necessary, since by selection from the natoiil 
increase the milk herd can be recruited and added to as the needs of the frtatfcF 
increase. 

RANGE CATTLE AND HOGS. 

One hundred head of range cattle were purchased in the spring of 1901 at • 
cost of $1 .990; 20 of these are steers, which with the Jersey steers will tunuA 
the station with fresh beef during the last (quarter of the current fiscal yetr 
(1902). Their value at contract price will Ikj approximately $1,200, leavixigoo 
hand 80 range cattle, the net cost of which will thus be reduced to approxi- 
mately $H(K). 

The station has a drove of 105 hogs of all ages. They have been raised at no 
expense (except for fences, i^ns, etc.), having been fed on the kitchen lefnse. 
Twenty-five of these hogs are now being fattened on station-raised com, and wheo 
Imtchered in Decemb(»r will yield ab^nit 5,000 jwunds of ham, bacou,8an8age,and 
lard, and materially reduce the exiienditunjs for these products. There aeems no 
reason why all pork productfl should not l)e home raised in the future. I>aiingtte 
fiscal year 730 i)Ounds of home-grown pork has been used. 



MABIlfS-HCHiPrrAL ffSMVlCt. 91 



ClIll'KRXll A%P HA 

Thfl* ni»«4fttf of rhftrki>iwi htm nn« hrr^t««f«>ff» pff^vr^n oroAUililf. pmrtljr 
jrvmbir hrtm r*mU\ ik4 hr imrt-haaml And lirUy liKr»ii«» tW Inmhftlftr wmi a r«iai- 
pMr failnn* T1it«M«i«« tbr«4<lfailiktti<d iMKlMHlctr bairliiiiirwM 

Gial r««Qlu ilf^tfiBlnir IIm» m— ki wlUi 10 rlilrki««. w«» m*w hmvm im. kAvtef 
W<l f«>r •ttl«Mi«c^ au Mvl Mtiaipd IW ImfilUl wltli 19i aa»« ttmk f«iriL 
TW ilrtiriAti bATMi kAT* i|t««» wi41. Ow» httwIrMl Mid fnrty wft«» <io hAiwl At tlw 
l»«nfinttiic of i1m» fhrmi jr««r. au5 hmwm hpptt kllM f«ir MilMl««r«». aaml %hm nnm* 
hrr bow 'ti hafiil la 94. Haiv* atv wvw fNit c« tin* hUl cif farp tvirr mnIi iih«|Ii. 
TVf wiU w«^h. dn— il. fnmStiil tHMtiMUf«rli.ai>llMl Ibi* vslw f>f tbtaiF wmI 

i«aib»r of f 



In »l«tit IliBi A flvflk-ftffit AnMlwr of guiaw idgv «r» \mwd te thi» darken jraid 
far thf» r nw »f H mtiUj wiiHi iif |Im> vCatftitt. 

Fr<ii tliiA tiBM* *m thf* vaIih* <if tlM> hta^m •Ua«htff«<d f<ir ftiial will Atamt t«iv |Im» 
vtfvtM*^ i*f iKr I hk-k*^ At>it karp jrsrvl. kmrlnK tki> pmiltnr •• |««dlt. I mvv 
r«rv*tit))r ftilil««it til tbr |«rtilti7 TATil A aqbiIhw fif MmiBA. vkkk ihat la* miawf 
wttkimt o^ At>il will aPTTv t«» fonikii a wrkuOM* AdditliMi li» tkf> diH Uat fiiC Triy 
iick f«tlrtita 

iMi%Art««s». 

It u iWirv*! tt> mAkr Arkiniwknlcintil *fl Um> fi41cfWiiiK dtOAtixMi tiiA«lf> dortnir 
tlir fUial yw^r 

Mum llrkif) M. «»«iiUd. iiT Nrw Y«)rk (tknm«k tk^^ Int^rnAUaiiAl CV«iiiiitt««r «ir 
tW Yimtiir M«« • (liflaCkMi AMtaiAtiKi). SuO bmiiid TvdiUBM f«>r tki» Ul«»ry. 1 
imiwUi^iir tnnaif- hm. t tmfti*klaic kAir Aad $^vrwm, 1 kAar HaII cmtHt. Aod a Btunhpr 
of xntUm^ itaidml 

HmmAn • Km-nd Hi«4Hy. of N#« Y<4^k. Vm bmuid TvdnmM fiM" llhrmnr 

Mr W V Tki<ii|«im. of tVit4tAii. N. M«*x..SiriirciQtlllA. 

( ttlUyrrm t,f tkf» Hrmrv hAti» di«Al«d i irdf oQlflta Asd audnr In Aad «iat dmic 
|put»«« «4krr» tntrr««lM| in thf> wrlfAfv of tki» NAik«» kATi» d<«AlMl hiaika. pi^al- 
trml* AOtl nrw«|ai|a>r». and Um> lilifmry now contAlai 1.959 TnlnnMa 4if iraal. wknk^ 
«i«ir Uaika. MTi ««f wkkk Aft* Akvljr lamiid. 



I kAvr hm\ A ff«»lf oKiniP Ui«l out Aa a kyictPBlr maAAnn* And tt fta QaMl rrmr «lAjr 
l»jr fn«i ail t«* a lUfN-n faairiita. It la rrinvftad tkAl tDAiijr dxnira of lavika fAiM 
til fftvff* tkrtr bAQiM. And UkAt io «^ <iAN|iftPtirr a|w<riflr Arkl»t»wk«dKlDmt «mii oi4 
bv iiiA«W 

ll««|»i*tftilly. 

P. M. t*%Aju»«in»«. 

NurynMi. if. H S.. la I '••aiaMt»«l. 

Si «••»••% 4«K%KAftl MkAl^K i|iMrtT4l. SffA% At. 

«'AKK or HKAMBK. 



'1 ht* |ini% i^itina mA4lr for the rmn* of Aaamrn for the fliirjil yrmr entl* 
inic Jiiiif .lit, I'.Ail, At all iMirtA whrtr rrlirf ia rf^ri>Ufly furni^hnil an* 
Ait*t fc»rth III m«|MirtiiM*iit rin*uUr No Ml, iUu««l June *», Hmh*. anti for 
thr IVmaI >rAmiiliii|» June :iit, itunf, in I^fpartment C*trruUr No. t*?, 

ilj|t«^l J till** l.\ 1<A»1. 



KKhHiTS OF FATAL CASES. WITH NECROPSIES. 



REPORTS OP PATAL CASES. WITH NECROPSIES 



MALARIAL PRVRH. PRHNtriors. 



K. r mg^. 34 y««ri. nmttr^**f tlM* t*BttMl HUiU«; wan adintltMl to l^iritlrmv 
ll<»{4Ud. WMihltitft««. U r .i M«>I«Y *3. IftIO: <linl 4 li*t«>l»-r .M. 

H»»i>»rf 4 In AiliuiMi*in !h«> |«itlrtit wah vm lU. with ni|4«l tioW mmI trtniatm- 
tor** of 4<i (* . M<|H* «ljr«|4»«rm. inlrtiiAMf UKb ft^ AtMl«if tbii'Wtanii lititK* in thr 
n«ht l*h>tti««l «>uuiituAti<<i Thf* skin IunI » faintl) yfll«*friab ttmc**. thr »|ilrm 
va» mlArtfnl U%wt iUm\titn\ No «*m|ilk<i |*rp«rfi! H«* IunI hjiil clonnir th«* |ir%*- 

rV*fia t«-fi «)«>• artrllU rhilU Atxl hftil br«« rX|aMf«l. hiniC •*»! til Um* Wrt Mid i-**!*!. 

Ri*tiiinAti*>n '»f tbr bkud Alutfrtwl nudariAl «inrasii«i*«. 

In •futv* i*f Urffr iIimm nf «|alntii«* h^taalrnsuMit-mlljr mn*\ tvr rwttun. Itrtfrt^m 4 
»n*l 4 crmtn* a «Uir Ivirnn aftf^ r«itnA wt tn. tlkpfv* van o*i tni|ir»irnii«-nt. antl tb«* 
pBtimt (liril aft«*r l*rtniro<nAt<aMi* ataiQt HixtM-n b«*nni. 

ytmrv •/ AKT. <if toff^lmm IrnKth. h^in •»/ •JtjrHiljr jrrllnvtiih tint c»vrr tK«* Unly. 
irtv^^ifth tn th«* iltAT rrtri«iMi. li%i<lit]r <*f «lr|vt»iW^t |M»rtkttii: <-a«Uivrnr riioiltty 
wril r«tAMulw«l |ia|>iU n«innal tn •xmt. nMw*} Sn-tk^i Wry Itttir fat uwlfT 
th«* akin llrtintlt' a(lh««t(inii **t taKh itlmnr r«|w«*tall]r «if th** Wfl |»i»trTi**rl% 
tr»€ti miwrt n«mrlT t«* th«* l«w frmn '.*'«» t«t .»■» «• r of >rll«>wv»h Until m nMO 
|»lrttr*) < a«it\ Kith )nn«r« ••-«WtnAt«>n« aJI •»«rr. |«tttinjr ««fi pn*^Rniv. hy|a«itJitt«- 
ivifiv* •ti'ti {•■»i«-n'irU At th«* t«wM» of ilk h wt*r*i* .m fh** U-ft ia«lr. Kih«-rv* a ««■■!- 
•tj««t arw-« wa* hr>taitii»«| aiiil nank in water. iIk* a|«i «»f th«* Irft Innir t'l^italiml 
M-ar« an*l twt» «ir tnrw* hani niatnlr* *»t a ftl«^>n« rKarwtf^ 

Thr {a-n-antinm f«itainr«t aUtfit l.*'it • of llnMl. hrart apfB-mr^l |«U«» atMl 
fUl>t'> a^Bxit normal Mf t Katnt«*r» fl-ui|4« wtth tin- rfti^«^|i*ti «if whttiah t'U*im 
rti» tflitiiT Into th«* ai^rta an«l |*nlnii<iar% art* ru-n iD«lQnitl«<i ««f i^irtii an«l initral 
«al««^ A •^•t'>U nitirmur waw a(i«liM<* m lif«* 1 

TT^r }n«*r wa* <*«ir*«tr«|. <lark in «• •!«•?. {awiilil) 4ltfhtljr rtiUrir«^l Kail I4aililrr 
|«r«iall> <«4la|«*^l t|ii4 fa aitfamrv*! niintial S|4«^^ wrtjcti^l 7l**irnun«. vrrv lanr«*. 
affftil w»a ailbff-ffvtit i«Vw^ m«ait t«f |ta <>i«|Tr| •nrfac^ ti» thf* aVli* «if tbf ala|««ntAal 
wall Hi** ttitrvtinr* Wf-r«> allichtlv «iut«-tiiM vrlth «». thf* a|i|«fiflix ai^l IVjrf^'a 
|aiti h«^ *|i|«mrvi| n-»nnal tV* BulBryra wrfw iMiruiat tn §««». ra|»nl«* vtiliii^niC 
tM^iuall^ >ftit *t^fT thr l«»wrr ««d <«f tmrh waaaUark pQn>l* atni oivt^nnic tl»* 
i**«rr rii.1 anil rgtrititinK n|twanl t*iwar«l tlM bilimi. *m tbr Ufl aliW tna-lmttntf tbr 
bilMUi TtM- •Q|«mn«al «a|«alf« ag na mn a l iiiifmal, m i— u trtti' nUotU aliirbtlr 
rtiUrtf«^l «l T. V 

MALAKIAI. rKVKH. HKIdTTKKT TrBEHrLK of LrK<»-IIITIiAL 

iXHrrrifiEXfY wmi HmrHuiTATMK 

A <t air« .*: yrmr% nattvity. Praoi^. ailmittr«l t*i tb«* Tnitirvl H€at«« Mann** 
ll>*|iitAl i-'ft i.f Han Kraiti-lMti. (*al . JttiM* I dlf^ Jaiw*» l«iil 



Hi^i-rTf Talkf-nt i««niilalnml iif a v'vrrv oiM ttn a<linWwii'fli. ba«l li«t w«-i|[bl 

bnaiWl 



«iM%«r« wnak b*il bn»larb«* cutinb wttb •imtum rbilU Imt iv* nitfbt awvmta. 
K&aiiiination ab^fWivl rtua«*latlt<i. •Ittllnraa fitvr tt|«|«'r bttv i»f ffinbi lunK. a|»*t. 
I«^h aittrrvir anil |B«t«-rVif c*f Wft lun^ Tbrfr «a« «liu>inial>n| rvamiaiMr i»«rr 
I* < r. InttfC* ltrr«i bintf r« 'Uitbriartt iH • r Air* Kt* luwi' 4i • 'f Irf t luntf !««■ tban ri|(bt 
llnari inirrtiiitirnt mural •y«t«4fc- murmur fmla* m|fiil ti-mirratnrv .tP* a 4' 
Ml f«i»<'|44 raamlnatViA «if afiutttm failrtl t*» abow tola-ri Ir !«■ ifli Mi« rt«K<it*i<' 
r tamitiall'<i of Mtaal abii«ii«l fil^tn'^lta malart«- |*aiimt In a f<*w tta>a Imam** 
%f-ry 'tfat^Airli liut atn— riit o4afiirtal»U <« Jnn» 7 tbr t|y*|itiira ni»t la-tiiir 
urir*^t Jaffa* » 4 JUa m . «W<atb. dor tflxanllai falliirv* 

ffwittmwHl 4 la aalmlaakiti faitkrai |Uai««l 141 wbuky rvwi tbrnr lM*tsr« ainl 
aium'4iium tbbifVta Aftrr tbr illai^vtf-r) «if tb«* gdaamiatu Warlmrtf a timturv* 
«aa tfttrti In %c I *\*mmm m^rty |w<» btmra. witb a dias lU c i- t«» antl< i|ail«* tl»r 



it6 



MAEISE-HUSI'ITAL SEBVICE. 



RvtfninK ';tiill. On June T patient wivi placet] on iitrychiiiDe Bolphate. and ll 
ainmiiiiiiuii cbloriilt: was Htopped. 

SirriijiK!/ (Uh h'liirK iifler lieiith). — Body of a yonnff adult male, fairly wt 
D<niriHh«d. ('ttiiaveric riKiiiity preeent. no euKjnllatiun.s; taeittht, 105 cm.; weigh 
•'io.4 IriloH. Brain: Weight. I :&iil grams: noruial. Serona effoskm in saUttn 
Hpai-e- Heart: Weight. 32« K^ains; pericardium contains 75 c. c. of a clear wia 





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fluid. Aortic TalvpcompetonHiyliydmstatictPfit; normalin appearance. Wt 
ralvi' inmifliciont; (Hwtenor flap shniiiken. Wall of left TCntncle hype rt ropM 
wall of riKht \-(>ntncln normal. Ri^lit pleural cavity contains quite an funonut 
fluid. Kih'lit Inntr: Weight, 5(XI griiinii: udhiTi-nt throughont; heavy buiA 
nlvnra. Api'xiim:u>IMHti-<l: rnvtiim hIkiwh militiry tnlxTcW: increase of Inter 
tUl tiMuc; middle lubo showii litrgu cuvity, 7 cm. in diuuieter, lined with a wUI 



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KKhUlTS OF FATAL CASfcS. WITH NECROI»SIES. 



REPORTS OP PATAL CASES. WITH NECROPSIES 



MALARIAL FKVRH. PRHNtrtors. 



K. <* mgf*. 74 T««ri: iuiltr«*of thf* rnitMl HUiU«: wan adiiitttnl to rmriflrmv 
||i»|4Ul. WMihtffitft««. U r . «M<»tfl^ ;». IttW: dM <k*t«>lirr '.*4. 

//lA/ory 4 Hi AiltulMl««i th«» t«tlriit VAii Yrnr til. wtth mpitl tmlM» mmI trtntinm- 
lor«* ff 4<» r . M<iH*c|)r«|«itrfi.fr«lrtiiA«*f UKh frrt mmIoC ilir Wtami DtitM* in th«> 
n«hi I*h>*ii-«1 «»uuiitiuiCii<i Thf* skin b»l » faintl) vrllcifrivb tttiic»*. thr »|»lrrii 
va* rt3lA»r«l. Iiirrf «|ii«i!»f ftil. N«» fns|iCi««i firrw nt Ar hail hjiil clannK th«* |ir%*- 
TVmA t«-ti Amy arvmU rhillji atxl ha<l lirm rx|viM«il. Ivttiic «>«it in tin* wrt aud f^ilfl. 
Rtaminatiiici 'if ih«> hkud •htivtiil malarial «>ripuilMii«. 

In ainir nf lanc«* «!•■«*• «if qtilntBr h3r|a«lmiiatlc-all)r ami yrt rurtisin. !a*twrrti 4 
atiil 4 tfraini a «Uv Iwinin aftrr c^muk «*t in. tlkm* van o<» lin|ir«iirrtiH^t. an«l tb«» 
patMmt t\%r»\ aftrr l*rtniro<nat<M* aUint AixtM-n b<*nni. 

ffmn '/ atfr. iif mf^ltom IrnKtb. ^Ikin ••/ idtuhtly yrll*twtidi tint «*r«-r tb«* UmIj. 
irrv^rttiftb In tb«* iliar rrirliifMi. Iivtilitjr <if <lr|«tiiW^t |a»rtiittii. ra^laTrni- riiOilttr 
wrll r«ta!ittidi«^t . |iis|iiU iHirmal in luar. mi<lwAy Sn-tk^i: Vrry ItttW fat nmlfT 
th«* akin Ilrnntli- »lhr«i«inii »*t Uich pU-unr. t^tv^-tally nf tb** Wft |»intrn«irh 
fr< 411 a|«r*i n««rlT ti* th«* }mm- frmii .'Vi i»» .»■» r r of %fn«*wub lliii«l tn nM'li 
|4«-nrAl • ««tt\ ili*fb InniT* ••'•I'tiMtiiii* all i««rr |iittinjr ^n pn*^Riin*. by|aaitattt- 
i-vmift •ti<ici {■»t«*n'*r}\ 4kt iIh* )«um« nf tai h wi»rw itn tin* l*-ft aid*'. KilH*n* a an*"!- 
MJ««I arra wan hr>taitu««il aiMl muik in wat«^. !)••* a|«i i*f tb«* Irft lunic i-k^itatiml 
trmm and two «ir tbi>«* hani n««lnlr« iif a fil«^>o« < liara<-t^r 

Tbr i^niai^ltam ««intainr«| aUmt l.'*»*- f >>f llnid; brart ap|B-«r^l |«U«* an«l 
llal»l*> aU>«it bi'imal »ti**. rbam)M<ni rm|>t> . witb tb** rii^pCii«ii of wbitub rli^la 
rxttf-nflinir Into tbi* •firtaanti |mhii««iar% art* n*«. lD«Iuratl<4i of at»nw anil nittral 
^al^v^ A •««t<>li( niurmur waw auiliMt* tn lifr ) 

Tft*- Inrr «a» • < 4iir*«tr«l . ilark in t* •!••?. {amilily •llKbtly mlarir*^!. Kail I4ail«lrr 
|mrtial)> •«>1U|«»^I. dui lAafifBmrv*! n«*rinal Sfdf^rn wHirb<r<il 71'*irrani». vrnr lane**. 
aii*l waw adb^Tftit ••vrr nt<at of Its convex »Qrf»9 t*i tbf »ii|t* of tbt* al>l*antiial 
wall Tlk** ttii«^ttt»r« «f m* litarhtlv dutriKM with ga^- thr apfvinlii attil iVjrrr'* 
%mu br« A|it«mrvi| n<*niwU Tbi* kklnr^ wnw normal in star. ra|»nl«» fitn|i|iinic 
biiniMlI> )>«it **%fT tbr ]«iwt*r ««il i*f tmch wan a dark tmrpit* arm roTrrtnK tbr 
|ii«f-r rb«l anil ritmiltnir nfiwanl towani ibr bilnm. *m tnr Wfl «4«W tni'liidinic tbr 
bilnm T)m* sQiiranmal «a|«alra a|i|Hiano| normal. mr««t«Tli' irlamU sliicbtly 
«t»Urv«l <» T. V 



MALAklAL KKVKH. HUMITTKKT TrHCHCLK or LrNci-MITHAL 

INMrrriflEXfY with HEf»rHf}ITATI«>K 

A 4t a«r« . .*: frmr% natirtty, Kraikr admittrti to tbr t'nttrtl Htaira Maniir 
||.»|HUl |».rt of iimii Kram iMt*. 4*al Jtinr I dkr«l Jnnti *• IWl 

iifi.'tf lUliriit • ofutilalnril of a Mr-vrffv ('«i|t| fill »tfnWi*'n ba«l l««t wrijfbt 



w*» \rty mrmk b*i| bfWWbr nmnb vitb siitituui rbilU. Imt n<i nijcbt •wrat» 
Ktaibinatiiin •bo«r«| rtua«*iaifci<i. dallnr«» iivrr nti|arr ltd«> itf rticbi lnnic.a|B*». 
I»4h aitirrvir anil {■•trnor of Wft Iniii; Tbriv mmm dumtiiabrtl rvaociaiMr utrr 
l«4f. IitliO llrralhUitf r>UKbrt»r«l t%** tkirm Kit tlMi<'lli>f Irft luntf U«atl&an ri^bi 

HoaM inirniiittmt mitral syatadk ntnrtnnr {lular rafikl truiiv-ratnrv .t* n < 
Mi' r^M 1*141 rtamliuitViaa of •|itiiuui failM ti> sh-'W inl«-ri Ir !«■ till Mii r««K«it'ii 

rtatnlb«l&i4l of Idiaal ■l|ii«r«l |ilAMn<«lia lUAUrliT |*ailrflit In a frW ila>» la^Amr 

«rf7 'lyafaBirli- liul atnia f iwl c-«4ufortaliW i4i Jnnr T. tbr ily«tin>i-a ni*! l«-lnif 
nrtfrtft Junr m i jua m . tiralb. dur t«i « ardlai fAllnrr 

Jtrnitmuml i9n ailmU0ii4i |«|imt |>lai««l *4i wbi«k> ^v«0 tbrw b«*nrB and 
aium«<iinm tblortiU Aflrf tlw- dino^t-r) •»f tbr |da«iu«Hlia Warlmric ■ tin« tnrr 
mmm g\%m In % «' « tUmtm ««rr> two Uoiarw wttb a doM» lu c < t«> antti t|aitr tbr 



J»6 MARiaE-HOSWTAL 8EBVICK. 

e^'eniiiK (hill. On .Inn? 7 patient kum placed on strj-chnuie solphAU. ndt 
tuninrmiiiiii i-hlori'lf whs slcippea. 

jVirrny«y Itm hiiiir* iifUr ilpitlU).—Bix\y of a yonn^ adult nuJe, furti« 
noarixhefl. lulaverio riKirlitv prewnt. no RUKgillatioiis: height. 165 cm.; M^ 
.W.4 kilw. Brain: Weight. \.:Viy\ (rrams; normal. Serous effusion in oUi 








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f«jj<< tt'Hiiijih*rn'i*\. fir'/'r *-*'fX:'.'h: Y*liO'.v c-I-.-r lii^n.- marked than in rt 
l'Au/\*Urr 'yyritr;»/»"i. ".r/aiii- aV/'it 1" '-. <■. "f ti'iirk. vrllowirih nrine. > 
rfji'ifjfira/i<T i-jiu/j--*.* 'i. T:,i'-k. aij'l j>n-fii^- *:x nl«f-r< <'U i.K»-.teri«ir snrfacv-. 
vary fi'/in IJ. ; to *;.; ]..;;.. in «liai;jM»-r: }ia*.>; a «• aii^.-T^'hat ifiinrheil-ouT appe 
t t«-ii*lifj;f tjif'/ii/li iii!i'-'/ii«r iijt-njljraij*-. k«-*tiiiii: Mmous niHiiilirane «."»»U| 
■ I'wl' fiurri /I'/r/ual. St.«/;ii;»' }i i:'.nrjal. Siuall iiiT*-stiii«-s imrmal. Large 
tj/i< I-.. Mij'orir ifii:rfjlir;in<r ««;ji;r<-T«-«l Tljn»7i;:l:nut. Liv»-r wfijfhs2.i:W ^raiii: 
fiiaM*-. h<!''t.i'/ii jin-K^-nfh «-vi«l«;ii/;<rs of ;rraiiiilo-fattv i.-liansrc"?. 

J. M 

a. V 

i;lci:ii of I':imoi.ottis-(j:di:ma of glottis— syphilis : 

ONlJAKV. 




ii>\rii<«l Willi noinnilM-iralrii i:r.i>isli m ;ilr-. >t]^aral» il by arra«i «^f solid 
Uk*m tutM iw in.uktMl SiilivMitaiit^Mi** l';it >. ;iiit M ti.M'lis wt»ll ilovt>lopeci. I 
limlii bt'iiMil il«i\\n h\ «>lil I'li'untu niilst >i<>i!^. n«> tlui«i in pifural cavity 
i«iiip)i>*>i'n):i(oiis aiiii I .»ni;t"»;t »l. Wi'i.cb.t. i. <•'»■' ur.tin> l.i.fr luiiv? same; ^ 
7»\^ m.'iiU'i IV'ru'aniiuiu noiKulhomu . .su* rontaiiu-il .'>i>it o. o. pale fluid. ] 



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100 MARINE-HOSPITAL SERVICE. 

SYPHILIS. SEC( )N I )A RY. 
Sirlctnrr nf n's(tftlnnjns. 

K. P.: iiuiii* 'Vi years; nativity, England: was adniitt^xl to the United Stat 
Marine HoHpital, iK)rt of San Franci^ro, Cal., February 4, an<l died May 2«, l!«i 

Histitrij. — Three montliH prior to ad mi ttance difficulty in swallowinj^ becau 
evident. There was no pain. ])ut pitient continued to get worse, until at time 
a/liuisriion almost everything luj endeavore<l to swallow was regnrg^itated. C 
parsing the cesophagcal sound two strictures were found, one 31 cm. and the oth 
41 cm. from the upiMT teeth. The passage of the sound was always followetl 1 
Kome ble^'ding. While in the hospital i)atient lost (ronsiderable weight; was v« 
weak: had small and rai)id pulst?, and a marked and increasing^ cachexia. Conj 
was distre.ssing. Shortly before death (K'curred iKitient was markedly dyspmi^i 
Stimulati<m was us(?d, but pati<nt did not rally. Loud, tubbling rales conld no 
be h'-ard over entire ch(;st. Death (K;cuiTed at 8. M p. m., from exliaustion foUoi 
ing inanition due; to stricture of cestipluigus. Treatment was principally larj 
dof«.-s of irxlide of x>otasli witli .stimulants and abundant food. 

Sronntsif im^'riiU't^n. hnnrs after (I'lith ). — The Inidy is that of an elderly whi 
male. p<Mirly dcvelox^ed and much emaciated. Post-mortem rigidity well uarke 
Suggillat ions are fairly well marked. Encephalon normal. Brain 'weighs 1.+ 
grams and is slightly c« »ngested. Lungs: Both adherent to diaphrag^m; covercf«l \ 
a deixisit of lymyih; cedenralous: float in watrr and crepitant thronghont. Le 
lung also somewhat adhcMcnt at apex: weiglit. left ooO grams, right 820 gram 
On swtion a jmrulent fluid <M>zes from tlie smaller bronchi and brtmchiole 
Pericardium contains alnmt ti") c. c. of yellowish fiui<l. Heart: Weight 270 gram 
small, pale, and flabby. Coronary arteries an? hard and tortuous. Mitral ai 
tricu.spid valves shrunken and insuffi<'ient. At)rtic iind pulmonary valves are nu 
mal. Large vessels have some fibroid changes near their l)eginning; the walls i 
the aorta are cabareous near the heart, and the desecndiug aorta, at abont tl 
l«fv«'l of the fifth to seventh dorsfil vert(0)ra. is indcMited by ])res8iire of an abnti 
mal growth in (esophagus. (Esopiiagus: At about tlio level of the fourth dore 
vertebra and extending to about tiie first lumbar vertebra there is a large ma 
infiltrating the walls of the ivsophai^us. It surrounds the bifurcation of the ti 
cheaand i»r».*sses on the l)ronchi as well as on the descending aorta posteriori 
B«'low. the mass is adhcn-nt to tli<.» stomacli. On section, the mass presenteil t] 
apjiearance of In-ing in a state of cheesy degeneration. Spleen, normal; weig' 
1^0 grams. Liver: Weight I. .'»(»() grains: edges roundetl; color normal. On « 
tion, the cut surface presents the typical appearance of the ** nutmeg " livt 
namely, a secon-lary fatty degeneration around the congested veins, evidencing 
sec )ndar>' cirrliosis of the liver. Kidneys: Kight kidui-y weighs 310 grams: ca 
sule strii>s readily: somewhat irregular; markings indefinite; liresents signs 
cyantJtic induration. Left kidney presented no marked differences from the riff 
kidney. Other organs normal. 

L* S. S. 
C. W. V. 
J. M. G, 

Pf/t'lifis — Mtfiiilis. rlii'iniir injln nninit i<iii nf' hlmUlrr (t'lirmiir Mnjjfptlittiitm) 

Ahsrrss nf l:l<hi('!i i jtffnnrithmsis) . 

S. A. S.: age. .V> year>: nativity. Pennsylvania: admitted to the United Stat 
Marine Hospital. San Francisco. Cal.. Fei)ruary 1: died Febiiiary 18, 1901. 

Ilistni'!! — F'amily history negative. Had mahiria four years previously. Hi 
a chancre twelve years ago. followed ]>y .sectnndaries. Present illness began t¥ 
years i)revious to admission, with in<'ontinenceof urine. He passed a great de 
of urine, containing a large amount of mucus and pus and had iised a catheti 
for two years. ( )ccasionally he passi-d blood. Ha*! cliills at irttervals of two < 



of heart. ^leiital condition rather unstable and confused. Memory very poo 
He liad a somewhat spastic gait. l*at«'llarrellfxes were greatly exaggerated; mil 
ruhir sense normal: tactile. ti^miHjrature. and i)ain s«'nse subnormal along disti 
bntitmof left internal sa])henous nerve. I'rine showi'd pus in large auautities bi 
no casts. Temperature was subnormal from time he entered hospital till dMll 



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10-2 MARINE-HOSPITAL SKRVICl!:. 

^'r T}]i' nn^'ht'xr.i iiUi\ tV»' sijnw of an jiffectioii of tin* (^hftflt and of pressure on tin- 
lir'jij'hi ii-'.-n-as*"*!. ami lattt^rly signs of pn»ssure on tht* gullet appeared. Thrr»- 
.vi'T*: I'lU'l iiiu<;oiis rales in tin* lunK>*. l>"t no physical si^s in the chest of a turn r 
of any hiz*r. 

.V< i-/v,y;x#/ 1 ftrt iihf-tmi hoitrs a/frr tU'nth ). — Rii^« >r mortis. Post-mortem liriditr 
in fl"i*"nd»-nt parts. Marked oniatiation. Imt not the most extreme. Oiwrati'jc 
j*f:ar on ri'^lit si(lf of neck fnllcjwin;^ line of sterntMnastmd miiscle and exteii<liii$ 
a^T'/S"* clavicle. N^xlul^'S in skin in center of s.-ar and at lower extremity. Serjn* 
liquid mixed with brit<ht-rolr)red 1)1o(m1 est -aiM.Ml from the meniu^es of the brain 
when tlie skulh-ap was removed. The ]»lood ve.ss<.»ls showed very clearlv. tht 
arterial radicals l>»'in;^ brij^ht red and the veins <lark. There were bright-reil 
jiat'.-hi-.- in the [>ia mater, caused by I'ullnt^ss of tln^ terminal arteries and caI)^lar^?^. 
the niort conspitruous one l>eing in the rigbt jKirietal regi«m. Pus escaped fraai 
the cliest when th<; fourth co-stal cartilage on the right side was cut. AnuaD 
alwe--, was found in tlie anterior nuMliastinum cm this side, central in the sixtii 
inte;* jacij at the junction of cartilages and ribs. A chain of eiilar^e^l Ivmpb 
glantU was f'iund in the chest reaching <lown from the right side of the ntn^k. A 
number of small, j Mile, gristly nodules w»^re found scattered l>enf*ath the skin in 
the ri*:d'»n of the neck wli'-re th" tumor luid Iwen removed by oi)eratiou. TheiV: 
was a whitish, fibnius. and fatty patch in the pericardium on the front of the 
heart. The cavities of tlie heart were filled with dark clott«*d blotxl and with 
smalli.*r buff clots. The auriculo- ventricular orifices achnitted tvro fin;;^er8. Tbr 
aortic and pulmonary valves held water. The aorta seemed dilated in the anrh 
and measur«*<l ]u cm. in circumference, but wjis not atheromatous. The puluionan 
artery was also large. The heart weiglud i^OO grams. Numerous enlar;j:ed. ilark- 
colored lymph glands wi.Te clustered around the bifurcation of the trachea awl 
the roots of the lungs. Purulent and bliwxly li([uid filled the trachea and bronchi, 
but no i.'rosi'»n of th»r tubi's could b«? found. The left lung w^s adherent in th^ 
lower part of the ]>leural cavity, and there were recent fibrinous deix>sits ou th-? 
])leura. Thi»n* was an abs(H'ss ab )ut '-S cm. in diameter in the lower border oi 
the lower lo}>i'. The whole lob* was in a state of red hepatization. The upptl 
IrjlM' crepitated slightly, pitted on ])ressure externally, and exuded frothy seruia 
from the vwt surfa<'e. Tlie lung weighed 1 .:i()0 grams. The right lunjjc was adher- 
ent alxiut tlie upiMT lobe. The whole lung showed the impress of the ribs. Tfe 
alwr-ess nr)t4'd abovt; as found iii the mediastinum had eaten deex)ly into the lower 
l)order of the lung, and several smaller abscesses were found in the nei^j^hlxmn^ 
lung tissu*'. The lower ]>art of the lower 1o1h» was solidifi(;d and friable, the uppt^r 
part (Tepi tilted. The middle lobe was in gray hepatization. The ujiper lol* 
was full of blood but (Te])i fated. The lung weighed 1.100 grams. The tesopbft- 
gus was not a<-tually obstructed, though i)re.ssed ui>on by enlargtnl Ivmph inlands. 
Fat was scanty in tlie omentum. The sjdeen weighed l.">() grams. Tlie nnprarezul 
iKKlies were Very soft and were ruptured in removing. The left kidney weighed 
150 grams. The cajisuh^ strii>])ed nKwlerately easily. The cortex "was very nar- 
row, the tissue jiale. The i)elvis of the right kidney was somewhat distended with 
urine, which had evidtnifly backed ii]) from the distended bladder, since the ureter 
was not obstructed. Th»? kidney weighed 170 grams. The tissue was deep red 
and the corti*x was tlii(!ker than in the left kidney. The bladder was firreatly 
distendi-d with urine. The gall duct contained bil«»; n<> gallstones. The bile 
ducts w«-ve i)atent. The liver weighejl 1.700 grams and had no unusual ap]>ear- 
ances «'ither externally r»r internally. The pancreas weight^l 70 |3^aiii8. Tw 
stoma'h <-ontained a little li<piid but was shrunken, and like^viHe the intestiiw^- 
The ai»i)endi.\ was slt»nder and curli<l uncler tin? ca^'uni. 

a. w. s, 

ADKNO-CYSTo-SAJlCoMA oF .LWV. 

K. K.: age. !<•: l)orn in ( V»nnecticut: adniitteil totheTTnifed 8tiit*.*s Marine Hofr 
pital, Ilostoti, Ma^s., DeceniUT 'jr,, lsU<»: died Augu.^t IS. iwoo. 

/{I'stnrif. — When admitted to thi.^ hospital an examination wa.s made which 
revealed a tumor about the size <^>f a hen's egg situated midway lM»twoen the sjnn- 
physis lui-nti and angli' of lower jaw and just Iwdow it on the right side. A diag- 
nosis of inflammafion of the lym]»hatic glands was mad«'. and i»atient was put on 
]H)tas.sium iodide. ( )n January 1. loou. an inci^ini was made fr»r the purpose of 
removing this tumor, but it was found so closely connected with the main blood 
ves.sels and nerve trunks that an operation was de<Miied impos.sible. On April 5* 
IIHM), ])atient de*<erted. He was again admitted to this hos])ital on July 12, IQOOl 
Ou examination it was found that this tumor had increased in size and was Twy 



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104 MARINK-HOSPITAL SERVICE. 

oflf. On section kidney shows <ongest ion. Bladder is c(>ntracte<l. rontainsft:^ 
aiiionnt of amber-colored urine. Stomacrh is lar^e, partially filled vrixh. llnj 
Pyloric orifice? partly closed l>y a hard growth. Dnodennm lx)iiud down to aWii 
inal wall by a hard growth which extended around the dnodentiin and aim 
obliterated its lumen. Small intestines contained hard fecal masses. At pb^ 
the intestine is constricte<l l)y j^rowth and lumen almost oc^cluded. On the rig 
side the appendix and caH^um an) firmly bound down to the iliac fossa. The lar 
intestine contains hiird fecal masses. Over the surface of the liver are yellovv 
white areas varying in size from a kemal of wheat to a silver quarter. The 
areas are liard and resistant on secrtion and are found throughout the entire liv- 
Gall bladder is dist^»nded an<l tilled with golden-brown fluid. The pancreas ia gn 
nlar on section and firmly united to the growth^in the duodenum. Mesentery 
contracted along its entire attachment to the intestine and contains an infilti 
tin^ mass, liard and ncKlular. In places it is diffuse, and in other areas it fon 
an irregular liard (^ord alK)ut half an inch in diameter. The microscopical eia 
ination of the tumor showed a scirrhua carcinoma imide np of a mass of det 
fibrous tissue containing s])acos in which were cancer cells. The liver sbw 
atrophy of the cells and an increase of (rlisson's capsule. The liver cells contai:» 
a brownish-yellow i)igm<»nt from liroken-down l)hxxl. Thronghout the liverth^ 
were carcinomat<jus areas. The microscopical examination of the x>ancreas shi*w 
no imthological changes. 

W. J. P 
A. D. F. 
J. S.3L 

COLUMNAR CARCINOMA 01^' STOMACH— SECONDARY nrVASION ( 

LIVER AND OMENTAL GLANDS. 

Clinical histori/. — W. Y., age, 5."): white: Inirn in Texas; was admitted Ap 
26, 1901, to the United Stat^»s marine ward in St. Mary's Infirmary, i>ort of G 
veston, with the following history: He states that ho has l)een fairly healthy i 
one month ago, when he fell and hurt his face. This got woU, and nothing fnrtl 
trouble<l him exc(»pt an attiick of pik-s. whidi l)led for one day and tlien ^ 
appeared. For three weeks, while he has had no pain, he has noticed that : 
acMlomen has l»een gradually getting larger, and there has been a swelling aft 
solid feeling alxMit the upi^er i)art of his belly for some time. He is habitna 
constiiwited. and for twt) wenks his ankles have Iximi swollen, otlierwisc he 1 
noted nothing alniormal. He has IkuI no epigastri(^ pain, nausea, or vomiti! 
On examination patient is (emaciated, an<l iiis ankles are slightly ttMleuiata 
His chest shows nothing almormal. His alMlominal wall is prominent, the skii 
glazed, stretched, and shining: the umbili<'us is protniding. Especiallv in 1 
epigastric region over the hepatic area is there a roundcnl tumor visible, whi 
is dull on i»ercus8ion and tiuctnates. A dull note in the hyiM>gfa8triiiin (patii 
sitting up) iH)ints to fluid in tho ablomen. His urine contains neither albnio 
nor casts, Imt is scanty. A noedU? intrcKbuHMl into tlui prominent epigastric swi 
ing withdrew a litth* dark straw-colorrd fiuid, and the liver conld 1)e felt at 
Imrd, very resistant ])o«ly ext<Mnling down almost to the umbilicus. 

On April '^*1). under eth«*r ana'*<th«'sia. an incision in the middle line above 1 
nml)ilicns allowed a laru*' amount of ascitic fiuid tt) esca^x.^, after "which there ^ 
revealed a much enlarged ]iv<-r. finely granular on the surfiwe. suggesting 
** hobnailed liver." with several largt^ n<Mlules appan*ntly cancerous; the stonu 
had a large mass along its greater curvature, and many cancer nodnles "^ 
found in X\u' greater omentum. The incision was closeil. He died next i 
(April ;;o) at 7 a. m. 

ycvrnpsf/ {St ri II hours iiffrr (Iriifh). — (Copy of re])ort by Dr. Allen J. Smith. p 
fes.sor of ])athology. University of Texas. ) The bo<ly at necropsy was that of 
emaciated white man. ai)i>arently ('►') yt-ars of age.."> fei't 'i inches m height, i>oo 
nourished, and weighim^ ])rnbably LM pounds. No abnormalities of atructuR 
deformities (rvident. No scars< r marks upon the surface ex(ei)t a recent snrgi 
incision alM>ve the uinbilieus in the m«.'dian line, done in explonitory opera ti' 
Slight ieterus. best seen ov^r the abdominal wall: liairof head thin, gray: bei 
full, gray. Muscles in abdominal ineision normal in appearance, hut thin: PC 
mortem rigidity slightly present, jnobalily having disaj>iH*ared. Pannicnlns a 
]K>sus v«*ry slight: a little ceileina ab«mt ri«;ht ankk-. Body heat disappeared, 
signs of decomiH)sition. Head, et^:., n«»t examined. Thorax: Thoracic organs 
nonnal jMjsition. Xo abnormality in diaphragm or me<liastinum. Plear^: 1 
right pleural I'avity t'ontaiiu^l 1l»2 c. c of clear straw-t^olored fiuid: there areaf 
old, firm, adhesive* buudjs iu the ujullary line at the level of the second and th 



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{».! ' -....'.',* y y. j.',v.i.}i in f ./; r. ^'lrT. a:i 1 in many in^^tanc-es when cnt appear v 
fr* *.**»..' 'J* /*•■'. '-rat. 'i i : tii-- ii:Nri'>r. .-oni*-tiiii*-s iin]t«u.*e<>ii.s. always freelypicl^ 
A.*:.' ri''-rj'«.". .-'MhI i':r»-*iii»- n-innal thr"ntfh«int. Appendix uormaf. 3 a 
I'/fjt' '». t ' ^'i. thi' k'. li<'- lit'h- 'if tlj" «':f»"Uiii. its five and coilinjc end towaidth 
r/j«-*i.an lin*- arj'l * "irviri;? ovt in*' *"lL:f i^f Th- iti-hns. Larse intestine nunM^ 
Ifjti-^tinal ''int'-fit- wa-Jj<r<l tlir in;:!] a >rraiii*.T nf ■■lieese cloth failed to show ■? 
para^.t" '*r aiiv ;.'ro--i ahii'trinality. Liv«rr: The liver, firall bladder, and * 
r*>uu'\ii,'/, rAii'ir-iu-'. vhnit\-i. totr<*th»'r with Th«- adherent i>ancrea8 (not septnK^ 
U" aii->- i'.j;«'<'irn«'/i r«-y<Tv<'d for imi-Hiiini. w*-i;;h f^ijfether 3.0-l4i grams. Theln* 
titfii-tirt'-. trarj-MT-' ly. :.''f 'in.: aiit<-rioriy f»r ]H>st»Ti«irly. 20 cm.: perpendicnllilv I 
I i « in. Tli«' * nrta/'i' of Mj*? l"ft. lo))** is rWjily crinKfr^ste^l. the seat of nnmezoiui^ 



<'af>-.nlar h'-rnorrhaL"-. This siirfarj* has lost its ;;lossiiiess. as. too. the under 
fiifi- lit \\n* «'niar«fd l<f!f lolf. and th«? whoh* siirfare is beset "with minnte nod 
ii'\ from «-ii Hiffsi-: h'-r«; and then* all ov<'r th«^ 8urfm:e and throughout the *^ 
Mtari'W', as -hown an s'-rtic;n. an< y«*ll'iwish-whit«* mxlules. the longest reachinf- 
t'ui. iiv irion* in diainftiT. <*nr'apsiilated and nmnded. of secondary cavff 
N I microns whitish |x»ints in the .Mcct.ion su^^cHt miliar}' invasion, and wlntiik 
Htn-aks Hhow in the cut Krirfaf' which are ]iroliably strands of acleroaed perikte 
hir ti.-.-rii'. nr iM-rliaps lines of lyni)ihati<- extension of cancer. The lumxTolfiA 
[Hirtions fif till* liver an* slii^htjy stain^^l with biliary pij?uient and nutmef* 
apIH'ararici* from fatty i n tilt rat ioTi. 

(liill bladder filled with li(|nid bile, and contains half a dozen small, irragahf 
r iilciili: w.dl normal, i'ancreas measures 1 i cm. in length: is the seat of a wk 
of hc'ondarv cancer, altontthc si/f' of an avi^ra^c |)e<'an nnt (oval shaped) intk 
head, and :ili>n;c the ^iip<'rior Inirder in the vicinity of the splenit; artery iffi 
do/en nr ni'ire (MiJarp'd. hard lym]>h glands. The subntance of the gland pn* 
Hi'nts no ^ross alt4>ratinns other than theabitve. M< '.sent ery apparently nonns^ 
Init meHeiitcric ^I'l'id ciin be fell di<tinct,lv :is minnte (enlarged) bodies (sv 
abnnt. n .1 i-m. bv <>.:{ em b\' o.'i i-m. i. Iirn>er than iionual. 



Mi'i>; i-WKSi-.KVKi) i-i'i: mi'i:ms(i)|'H' kxamin \T10X. 

I Wall of left ventricle uf liearl in si:it«' of atrojihy. tlie interstititil (*onnecti«' 
tissue deciiledly iiicrisised: muscle filN^rs much pigmented: inotlerate fm jF iw- 
tat ion iif fibers; many libers atliropic; Meigs's intermnscnlar capillaries nd 
marked. lUond vessel walls thi'kt'ned. modtM'ate inliltration of epicardium. 

'.'. I'apilliiry nnisrle i.r left ventricle simihir to above. 

:i \V;ill I if rirlil \entricl«' similar to wall i»f left ventricle, intermuscular COB* 
ne« live li-^siie. Ms u^ual. more marked th;ni in left ventricular wall. 

t .1. Ilil-^ of superior lobes of riuht ami left Iuul^s. Both lungs show in tk 
arteriole*^ auil in t lie capillaries in the walls of the air spaces numerona plngnal 
HIS -out la r> cancer of same type a*< s»'en in liv<«r. No clear lymphatic invnltt- 
meiit. In a few spots borderin<^' on thes(> minute fm'i of cancer the air spacostiv 
occupied by ])neumonic exu<la1e. Mfwlerate ])i.i;mentation: otherwise nonniL 
Si'tion of spleen. marke<l con^j^estion. TralM>cuhe and ves.sel walls thickeiiBA- 
Mmlerate pi Lament at ion. 

«\ SM-tion of 1{idne\s: Slii^ht thickeniiiK of vascular walls^. irregular congestlai 
nf imlixiilual vessels. es]M«ri;dly vasar«'cta. Slii^ht intertubular connective tifltf 
hy]H*rp1asi.i. S'attere<l. cloudy swellini; Im cells of cortical tnbulea, UtcI0 
iiornml. 



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108 MARINE-HOSPITAL SKRVIOE. 

woniul: anodynes to initiKat.<^ Inn suflferinKH. 'iu«l chloral, ]>roini€le8 and hy« 
hy<lr(»l)rouiate to control the delirinni. 

Nt'vropsy {nine hours after dcdth). — B<xly tliat of a well-develoxxMl ma 
whittj male. Head, face, and nock extremely swollen, with blebs in placet 
lids <i»doniatou8, eyes colortnl as a result of the erysii>elatou8 inflaiutulatiim. dj 
inf< features almost beyond recoj^ition. Depression in forehead over fronta 
about 5 cm. in length. 2 <^m. in depth. I cm. in breadth, resulting from a 
fracture of the skull. A recent injury over right eye caused by faU. A lac< 
wound of scalp, 2-^ cm. in length, caused by fall or blow, lix^ated ovei 
of occipital bone, about 8 cm. to right of medijin line between the sn 
and interior curved lines. Bone exi>08iKl, but not fractured; pus exuded 
wound. The scalp is bjggy and (edematous, discharging from several pL 
aero-purulent matter. Right knoe has rtK^ent wound from fall, abont 1 o 
diameter. A cicatrix over left thigh. Posterior asi)ect of body discolored 
from ecchymosis. Rigor mortis marked. From incised ti.s.sue of neck and 
over the manubrium a bl(M)dy sero-xmrulcnt discharge flowed freely niK»n 
pression. Tissues soft and infiltrat^^d. Thorax: Pericardium thickene<] 
inflamed, and contains about *J()0 c.c. of serous fluid. Heart small and tx 
with fat, largt^ ante-morti»m clot filling right side <'f heart and extending 
into pulnwmary artery. Aorta slightly thickened. Hydraulic test demons 
comi)etency of aortic and pulmonary valves; mitral and tricuspid valves t 
ently nomial: weight of heart, UOO grams. Right lung weighs 8(X) {^^ramt 
5()0 grams: right nedemateous; a frothy material exudes from incise^l su 
glottis (edematous. The erysii)elatous inflammation had extended into the 1 
and trachea, where mucous memhraiie presentt^l the characteristic apx>earai 
an intense inflammation. The surrounding tissues were invaded by the < 
sion and present similar gross lesions to those already described. Abd( 
Liver weighs l.iK)0 grams: ui)on se(*tion bleeds ea.sily: substance, friable; 
norm: 
aiK 

normal; 

Intestines distended \vith gas. Calvarium n^moved with difBcnlty, o"wing 
great thickening of the bones, which exceeded tliat of the Airican sknll. 
cap som(»what (;l>long in sha]K* and flattened on top. The vessels of arachnoi 
pia mater were ( ngorgfd an<l red. The two iiK^hibranes were closely adher 
phices. The m«*iiil)ranes were evidently in the first stages of an inflamm 
Weight of hniin. l.*J."»0 grams. 

J. T. 
W. P. 

MULTIPLE FRACTI^RE OF THE SKULL AT ITS BASE. 

W. L.; seaman: age, tJ2 years: native of Caiuida: was admitted into then 
division of the Buffalo Hospital of th(; Sisters of ('liarity on May 10, 1901. 

IFistorif. — Patient could giv(^ no account of th(» injury which he had snsta 
sav(»that hohiul fallen and struck u])<m his head. It was afterwards leamet 
he had fallen into \hv hold of the steamer »A>//// IT. Moore and when pick 
was unconscious. 

Present status. —Hi} is seniiconscions: the ]mpils equal find react to lifcht; 
HO and of good (juality: no loss of sensation or motion. There is blee<ling 
left car, a large contusion of left occi]mt , and a bmised area aloni^r the lower( 
region. This condition was <iui<'kly followed by loss of ctmscionsness, dilal 
of pupils. ]>aralysisof the niuxles of deglutition, stertorous breathing, 8om( 
vulsive tremor of both lunids. and death three hours after the injury. Ther 
at no tini(» tln^ possibility of rendering surgical assistance. 

Am Toy AS//.— Body of youiig adult nial«^ in full hf^altli: riiror mortis commei 
There is a eontnsion (»f the seal]) covering the left side of the (Occipital boni 
the su]>erior curved line: there is a flow of bloody serum from tne left eai 
over the lower dorsal region there is an cjval tTunefaetion 1<) cm. long^. Calvi 
removed: scal]> tissues inliltrat<Ml with blood at side of contusion; ineninffa 
g(»sted: brain normal in appearance. In the fossa* of the base of the skw 
are several frjictures. In the left middh* fossa tluTO is a Y-shai)ed fractuTC 
comnnnicing in the ])arietal Ixnie near the squamous juncture, crossing this 8 
and extending forward and downward, and backward and downward thl 
the sfinamous portion (►f tlie temporal bon(\ the anterior line in its conrse w 
ing the anterir»r branch of the middle meningeal artery, the posterior line • 
iug the iKitrous porti(Jii nf tlM» t«'mi)oral Ixme. involving the vessels of then 



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110 MABINE-HOSPITAL 8EKV1CE. 

an<l Thnrs<lay morning, while cleaninj? decks, he fell, and when fonnd was m 
t^t'ionn.'* On Satnrday the jMitient was brought to hospital, and at that time 
jinwrtically nnr-oii>K.'iou.s, although he could be iiartially aronsed by a loud t 
PhvHical exauiinatiou showed the left ami and left leg l>'ing perfectly limp. 
wh»-n raise^l and reh^awed falling 'wdth complete relaxation. ()n the right sid 
mils' 'les of the fa<;e were drawn and the right comer of the month was elevi 
Omjugate deviation of the eyes an<l h(;ad to the right side. The papils she 
no irregularity. The breathing was stertorous and the pulse slow. There 
no rrontrol over the sphincter muscles. Later the facial paralysis liegan to imw 
and the mental (ronditir>n clear(Kl to such an extent that the patient could 
with a mmlerate degree of intelligence. Control over the sphincters was regi 
There develojKjd. how(?ver. a chronic contraction of the muscles of the lef 
and arm: much more marked in the latter, in which the enx>w was some' 
flex^Ml and the wrist and fingers extremely so. Three times dnrinjc the j»ti 
stay in the hospital a cimvulsion. epileptiform in character, develop€»d. The 
two were neither severe nor of long duration, and the intellect, although d 
for a day or two. then rt'gained its normal, or usual, condition. On the after 
of February 10 the last and uiojst severe convulsion develoi>ed, continniD; 
nearly an hour, the patient passing from this condition into a comatose stat^ 
dying alnmt 2 o'clock the following morning. 

Stcrajtsy {firrlrc hrmrs dftrr (hath). — Height, .> feet 6 inches. Post-mo 
lividity well marked. Rigor mortis moderate. Pupils dilated. Gk^neralnoa 
ment T><M>r. Circulatory organs: Heart — Unusual development of mtUK^le \ 
All valves wen? (^onii)et(?nt : weight. 490 grams. Pericardial sac normal. Art 
exhibited slight sclerotic changes. Lungs: Weight of right liin^. 470 gram 
left, iJTO grams. Both preseyited a fairly well marker! hypostatic coni^estion. 
h.'ft x>hMiral cavity was normal: the right showed slight plenritic adhe^ 
various places. Gastro-intestinal tract normal, with the exception of an elonj 
and adherent appendix. Liver: Weight. 1.250 grams; somewhat congv 
Sple<*n and jmncreas normal, excejit for a well-marked sulcus miming transve 
across the outer surface of the sx»leen. Kidneys: Each weighed 110 g^rams.ai 
Ijoth the capsule was lulherent, the cortex thin, and the pyramids nnusuallT 
dish and mottled. The urinarj- bladder and ureters were normal. Nervoni 
tem: The dura mater was d(?cidedly congested and somewhat adherent along 
sides of the longitudinal fissure?. Bniin: Weight. 1,.")(M) grams: cortical p« 
injcKited. (.)n secrfion the right hemisphere exliil)ited a reddish-brown \ 
involving the lenti(-ular nuc^leus and internal capsule, in wiiich there had a] 
ently ])een a i)rolif(»ration of connective tissue ancl resulting scar formation. 
was considered to iKi the* position of the hemorrhage, taking place befon 
pati(»iit was admitted to h«)sidtal. Tlie left lat<»ral ventricle was mled to its ul 
capacity witli rejcentlv effused dark-n-d bl(K>d. 

W. C. 
B. W. 

MENINGITIS. 

F. W.: age, Wi\ nativitv, I'nited States: admitted to United StateH Marine 
pital. Baltimore, Md.. March 4, lOOl: died March 7. UM)]. 

///,s/r;/7/. — Upon admission to ho.spital tht< patient's mental condition waa 
that no history could be obt^iined. It was learned, however, from the capta 
the vessel upon which he had been (tniployed tliatthe illness had lasted aboul 
weeks, all of whieli tinu^ the patif-nt had iM'en alw^ard of the ship. Physical c 
ination showed tin* patient to ]>e in very shaky condition — the face dnll, ccMij 
tiva' injected, tongue tremulous and red at tip, covered posteriorly "with wh 
coat. AlMlomeii tympanitic and tender to toneli. Slight subsnltus tendh 
Axilhiry teinp«-rature. '.V.) ('. Pulse. lOJ and very weak. Respiration, 20, witha 
bronchi;il lu'eathing over a small area in ])osterior portion of left lung. TIm 
after admission the ])ulse was weaker, the breathing more irregular, anc 
mental condition that (»f muttering delirium. March (>. the condition remi 
th(» sam< . There was an involuntary movement of the l)owels. which waa 
thin, offensive, and slightly yellowisli clniracter. At VI o'clock on March 
pulse could not be felt at the wrist, bnt ]»atient resp«nided to stroniF stiz 
tion: the rally, however, was of short duration, and death occurred at I o'* 
that night. On admissiim to hospital a rose-colored rash was observed on s 
alxlonien. and thighs. Did not disapi)ear on pressure. Some si)ot8 were pete 
and some very small ones luanorrhagic. 

Necropny (eight hourn after death). — Height, ."> feet 10 inches. G^eneral nOA 
ment good. Pupils dilated. Rigor mortis marked. Po.st-mortem lividity 



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112 MARINE-HOSPITAL SERVICE. 

hr)t milk were injected i)er roctnin ovory thri'o lionrs for the first tiRro days. wl« 
it was given bystouiJii'h tnhe. Within sixty hours tht' patient's iiientAUty clfAiw 
sufficiently to reply to cpiestions ihtellij^ently by ncxldinj; or shaking Ids be»l 
though wiK»echless thnmgh inec^ordination of muscles. Couipbuxieil of headactr 
in frontal region extending over vertex: earache in left ear: read large print. aK 
swallowed fluids, tlumgh with difficulty. The ear was again examined wita 
negative results, and fre<iuent cojnous irrigations "with warm boric acid. 2 pw 
cent solution, begun, with hot-water bag ai)plitHl, which seemcnl to fj^ive mwi 
comfort. This was discrontinued on March 19. and two drops of warm oli^*e(t 
and tincture of opium used instead: chlort)f(^nn liniment was well mbbed at 
X)aralyzed liml)s. Urine throughout nr>nnal. 

The left bronchial momoplogia without loss (^f sensatitm, and paralysis of leftkp 
and thigh, which became api)ar(?nt c)n riKrovery of consciousness, lessened jw- 
ceptibly. The excretory fimctions wen? almost reestablished and the patient wk 
apparently improving, although still uiia])le to speak. On March 21 the »yin> 
toms gradually increased in severity, and in the evening the entire left ai 
lK?came i>aralyzed. Preparation was made for operation to be had as soon asthr 
light was suffici«?nt, but the x)atieiitdied (juietly at oA^) a. m. May 23, 1901. Tlfc 
temiH.a*atur(? chart sh<)ws nothing of interest. 

Accro^w// ifirr honnt (iftrr (hath ).—Ji<H\y that of an adnlt "white male: 1.** 
meters m height: weight. 70 kilos: muscuhir and fairly well nourished. Rijp:: 
mortis in lower extremities, but not in upper. Post-mortem lividity faint. Sil" 
cutaneous aref»lar tissue ai)parently normal. Anterior mediaatinnni and or^raB: 
of chest and alnloinen api>arently iionnal. Bladder: Contains about (KH) c.c. 
urine, no i)athological lesions. Brain: Entire cortex of left lieniisphere is coveiw 
by a clot of blo<Kl, i)artially organized and sulxlunil. A portion of the clot an* 
riorly and 3.5 cm. in diameter is apparently some days old, whilit the postent 
<»ne is larger and of recent origin. The* ]>osterior cl<»t is formed by a mptuwf^ 
the ascending parietal branch of the middle cerebral artery. The anterior hrfs- 
orrhage is undoubtedly due to tlu; rupture of a branch of that artery, bnt thisf 
nn<lemonstnible. There is no c\ndence whatever of injury to the sknll, and tbf 
(tanse of the hemorrhage is difficult ti^ as<ertain. This case is of specdal intfTvS 
in the fa<'t that the sym])t4)ms inunted so strongly to the legion as being on i^ 
right side, when the hemorrhage was on the left. 

A,. M. 3I- 
M. J. W 
J. M. G. 

I)K(;^ENEKAT1()X SPENAT. CORD. 

Aitfrriitr col num. , 

J. J.: age. \^ years: nativity. Uenmark: was jidmitted to the United Statp 
Marine; Hospital, i)ort of Sim Francisco. Cal., on Jul v i:i, 1897, and died Jane *^ 
11M)1. 

Ilisiory. — Up to two years previous to admission was a healthy, vic^cMtnis mtt 
Nf> venereal hist.*>ry. Ajjplied for relief from dysjM^psia and rheiimatisui in am* 
Two years befor<' admission had chills and fever, to which he tuscrihed hisillnest 
At that time ha<l a numbness and sliglit j>ain in small of bm*k. Almost imnv- 
diately aft<'rwards there aros<^ a gradually increasing weakness of the low? 
extremities. This increased until he (Mitered the hospital. At tliat time he WV 
able to walk witli aid of crut<'ln*s, but within four months he lost the power to 
walk entirely. His ln»w<*ls lu-canie constipated and his urine dribbled, rlislnnfl 
wen» normal: heart normal, except a sliglit ai*<-entnation (»f sec^md aortic soml 
There was a marked ])ar»sis of lower f?xtnMnities, but no atrophy of the mnsclA 
No areas of anesthesia either of tem])erature or touch. Anidrosis over lx»th lip 
was complete. The knee j<'rks markedly exaggerated. Ankle and rectnsclontf 
l)resent. RonilKT.g*s>ign waspres«*ut. ( )ver thetliinland fourth lambarvertebiC 
a scar, result (»f an injury at age of 17 years. No disability resulted at the tin* 
Patient continued to lose power of legs and also to have incontinence of nrinean^ 
constant and ol»stinate constipation. On March 'I'l. I^IW, a lachrymal absceV 
develi>ped, which disap])eared in a few days after ])assage of Bowman^s probe as^ 
irrigation of canal with boric acid solutinn. Patient's legs continued weakff- 
and stry<-hnini' was administered hypodermatically with massage and the faiidk 
current. He complained <d" continual hejidaches and freijUent luictarition, e4^ 
cially at night. 

Maij Hf, i.s'.f'.f.— l.'rine examination .sliowe<l pu.^. Numlx^r of mictnritions incitt^ 
ing. ConstiiMition was still continuous, bowels moving only when sttmiilated ty 
drugti or uueiuata. 



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114 MARINE-IIMSPITAI. SKRVICK. 

Ft^jrHiinj ./.■„ /.''"".— CVnnpIai us ■)f tn-mors and jwiii iu legs ami anus at nigb. 
Ti^tide Ifecame hirgn and tender. Scrrjtnni thick and (vdematoiu'. 

M'in-li I'i. H'li'i.—A. pf'riiieal fistula waa fmind. thnmgh wliich mout v)f ihunrm 
KHCaped. Urine vwry oSeiutivi-. Putiuiit continued in this condition luitil Mant 




18, 1901: at times he would havi' an inrnKWf i 

ConHti]>ation ahenmb.'d witU diarrlii':i of a IjIihhI; ^ 

n ined, at times dis»;hjirKiiij( a iiurnleiir, llniil. An i.-M-liii)-riK-tttl fistiila 
d. Pationt at times saSercd fnim liea<liiuta<'M. nausna. and vomiting'. 



tho intensity of hja i^-r myM i* 
.... — xhf lietola in pertajni 



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116 MAKIN»HOSI'ITAL 8KRVICE. 

.\t>fropAi/ (fh Irtt/ h o ?/ rs a fU'r flm Hi). —Height . 1 . 7 J J meters : weight . To kilo». Bd; 
is truit ijf a wr-ll-iirmrishtMl whit«.' lulnlt iiialo. Rigor mortis "well lu^irkeil. Sugiriij 
Tion.s fairly well markc*! all uwv th«* lMnly. Brain: Weight. 1 .-400 jyrraxns; aliiiliLi 
roriu'<"Ht.<-rl; ofh«'r\\'is«? n(»niial. Spinal cord: Dnrii anilcortl normal in grossajipa: 
an*-*;, pfjricardinm normal. Heart: Weight, HIM) grams. Aortic and piilii-<:i!> 
valv»-< ii'innal in apiK-aranct!. Heart muscle apparently normal. Lungs: I/^ 
weight, 5:50 grams: crepitates, floats in water: apparently normal; right, weigt". 
T'l') grams: a^lht*rent to jilenra an<l diaphragm: floats in water, crepitates: appt 




and un-ter: ]»elvis very much dilated: cortex diminished, a small, cirenmsLTi^i 
al»«<;«r^H cavity found in the cortex: markings distinct. Right kidney: Weis? 
I*^"> grauis; cortex thinin*d: pelvis somewhat dilated: markings distinct. Bladder 
Willis extreiiM'ly hyiM*rt.ro]»hi<Hl: nbout 2 cm. thick: ca\ity very innch le*eiK 
capa^'ity reduced to alxnit oO c. c.: contains a purulent fluid: inside of \A%^^'^ 
sl'owh ojKfnings of a nuiiilicr nf flstuhe: one o]K'ning into the rcKrtum. 

L. S. S. 
V. W. V 
J. M. y-.. 

(iAiMMATors Tl\M()Jt ( »F THK BRAIN. 

J. J.: admitted to th<^ Uiiite<l States Marine ll()s]>it4il. Stajdetou. Stateu I>li: 
Sf'ptemlM'r ix, IIMM): age, oT: nativitv. Norway : last employed on schooner '»> 
Ik ( 'hanihrrs; died May ID. VMM. 

llisfiirif.- The patient entf?r(Ml tin* hr»spital formerly Alarch 2, IdtW. bh 
naiiained under treatment at that time until Septemlx»r 17, lUOO, the diasttS: 



reacted to light and ac<M)nmindatinn, hut thf? righr whs narro>ver than thelef 
The jiatellar r<*flexcH wen? ahsi-nt. There wa.s no cvi<lence of anc^thosia auvvbt** 
There wercj no clear (external signs of sy]>hilis. He gave a history of having W 
venereal disease about lifto<!n years i)r<.'vi«>usly. Treatment ha<l np pereeptTir 
eff«^-t in checrking the slow pn>gr<'ss of the disease, which was characterized tf 
loss of inTVous jH>wer, in the mental an<l motor systems imrticiilarlj'. Vi-*' 
failed iilso, and the com]>laints of pain inlu'ad and feet were moro or less consttC 
Till' patient was ahsent only one day fmni tlu' hospital, when discharged in >? 
temln-r. His condition i)rogr(?ssed steatlily. until at the last ho 'vraa complft< 
helpless, demented, and blind. The symptoms by which a tumor of thelffii: 
<'ould have been diagnosed and itsjiosition definitely loeatvd were never olear.afr 
then* was mu<-h cause for iM-lieving that the ataxic symptoms wei« diietos 
aff(H*tion of the spinal cord. The patient died in (M)mo, having had a nninMt< 
Kimilar kih*11s previou.sly, which laste<l only briefly. 

Sirropsif {si.r /tours (if l( r <irnfh).-~VnH\y w'vW nourished and muscular. Pa* 
mortem lividityand rigidity of dependent jiarts in<Hlerately developed. Pupfi 
moderately ami eveidy dilated. KiLclit little lingfT mis.sing. Two small ukrf 
over intf'iiial malleolus, extending deeply into the skin. Epidermis of ri^ht 1» 
hM>sened. showing red derma beneath. SkuUeai) thin. Meningeal vessels full'* 
dark, fluid blood. Superficial vess(»ls of brain contained dark, fluid hlood. i 
tum<»r was f<»und in the ]>rain <'ase above the tt'ntoriumc»;rtd)elli, compressing A 
cerelK'lluni and ]>ons and the ncci]»ital lobes of the brain. Tho loft occipital lob* 
was greatly thinned, tin' surface markin^^'* and gray cortex being obliterated o( 
the median surface. The rij^ht lobe was cunijjressed to a le>s ext«nt. The tmwi 
lay about two-tliirds to the left and one-third to the right of the median line. I 
weighed ;J'.*0 graujs and was marly the siz<^ of the closed fist. It 'was fiioi 
jMlher(*nt to tlnMluni. but not tt) tin' brain tissue. Its consi.stence was firm f 
the surface niKlular. The bone ovrr tlii- tumor was eroded and so thin as tot 
translucent. Tlie great longitudinal sinus was obliterate*! completely where i 
]iassed over the tumor. Tlie cut surface of the tumor appear(»d fibrous and lix 
an arboresi-ent arrangement: it cut with difliculty. A si>ecimen a'lx>nt 15 CB 



h)iig of the spinal cord jn-e^'uted no ]Mi>*itive gross lesions, (.hi opening abdoo? 
sulHutanerniM fat was frmnd in good (juantiiy. The skeletal mnscles tyeie lATfl 
and dark <'o|i»r«'d. Pericardium contained a small amount of clear Be mm . H6S 
IumI c«»nsideraMe fat on surface; w-iglit. ."•')«» grams. ()pi»ned in situ, hrf 
ventricle contract»M]. Right ventrich' contained clotted blood. Mitr^ Til* 
admitted two finger tii»s; tricuspid two lingers entire. Aortic and pnhnootf 



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] 1 - MARINK-HOSPITAL 3ER^^CE. 

...iV '.IfOM.SM— liKMRITM TR?:MKNS— (EDEMA OF THE BR.VIN 

;*/*-. ;;j: uariviry. Xhw Jits^'v: ailiiiitUMi lo the L^iiit*-*! Stat*> M^: 

//"• . •/. Tv.-'> yi-arn a;<i> |>ati«*iit «'X]M'ri«'ii: nl an attack of piif iiiiiimia. < 
;:.', ••.•:. Jij • ij«* '.va- -nh.;»-<-tf'i t«) ^'Xpusiin* in a s«? vert* storm at s»^ii, flnrin^ Vj 
..:- :»r» • uti'] 1 ■;;- wi-n* dr»'inh»'i1. Soon :i!tirr wards his extremities iK'irau t«» «^ 
;..'.'! ;.a;;." ar.'l *riiiii\ts in tin* ^a>tnK'n«*niii imisclrs <lewl«»iH.Ml. <>ii aihuiv 
•:, .-■ wa- ;i -n;»«-rfi'-ial tranniati«- uh*eratinn «m the riirht 1 s, ami Imth le;r?« 
-v. '.;.*•.'. ;i!j#l «f'<l< iiiatoM.- to tin; knees. Fn-qiifnt and painful uri nation wa>:r 
*." --.r:.' -yin;it I'd. th»* oiiM-t of whieh dated from th»' ex|M>sure refr-ml 
M'»' i'/n oj t! •- jiiints i-aiiM-d j>jnn after a total alistinenre of two years. Far. 
i.iv: * • ♦-ij 'irinkin:^ «-xr»"SMVi'ly for thrtM* \v«'fks i>rior to admission and In* b*!-- 
jf!<**- anop-.\i;'. iTi.'«< zinnia, and a <-ojirs*' muscnlar treinnr. His mind was i :■ 
Th*- ;..!•*• -..a'. Ijo. full and iMinndiiiK. TeuiiM Tat lire normal, and reuiaiiiri 
^tiT'r.irt.'.tr. ilhi'--. Th*- urin*- <ontaine»la lloeulent »e«liment, a tra<-»»<if albin; 
■Ait'i a t --.v }.>alin" and Kranularc asts: sjiennatozoa werei)re8:'nt in lar|;e nuini« 
;?.j-o ' al' .iini oxalate ery-tals. round cidl'd epithelinni. and pns fell.**. Th«*r 
r/i«-r.^'''i/;-,-twi .,f «-xrrlusiv*Mnilk «liet.an initial piir^^e with bliio nias.s U.<»: tIdlt 
'■silfi'iiiii III. X t. i. d.. and rliloral hydrate 1 j<r^ini. with ix)tas.s. brouiitl. '2^. 
every f'lWr liotirs a.s nt*<r4*ssary to indiiee sleej). 

O'-f'th^r I'.. -Patii-nt, l>«M-ani»* <-xtrt»tn»'ly nervous and develoiKMl balluciuat 
and d<lM-ions of variiMiM .-ort-. The use of hypnotics pnMlucea little eff«.*l. 
'tfifU H-: patient el ojM'd his i-yes li<» saw various o])jec-ts. principally headlv;^: 
lual-. fnneniN. ^-nake*;. ♦•t«-. \i whisky :iO c. e. and tr. di^talis in. *x t. i. d. 

thhthrr /-'. Th*' HW(fllini< of tin* l«';;s cntindy disai»i)eareil. The pnW. vi 
had >>«-eonie feehh*. improved under tin* ahi»v«' stimnlatiim. hnt imtient Wi 
deJirioUH and tonun*- was tremulous and lieaxily furred. 

I h-lnhrr .''/. I'atji-nt. recpiired restraint tt) keep him in iH'd. He t^>re some^' 
\^i\ r\iA\\\\v^ and had a muttering delirium. Whisky and eapsituim ditKHiiitim 

th'fi,f,rr ..'.'. Stnpiir d«'veloped. The respirati»ry murmur wjia found tolief« 
ov«r the has4 s of the lun;cs. and dullness pr<*v;iiled in the same rejotm. Raur 
niuni earlnaiate, O.H t . i. d. 

(frtofnT J''. There w.Ms ri»u;^h "witli tenacious mucf»u0 ex])ectoratiou. Cyan 
and excessive tn-mor: derp stu]»or; breath excessively offensive. The hrt 
JM-Iion was fe^-hle and jMitient had incontin<'nce of urine. Quincke pnnctcr 
Hjiinal canal iM-tween third and fourth dorsal vertebne resulte<l nej?atively. 

Ortnht r :i.. Th»» jnilse rati", which had r«'ju*hed U) lt»0 l)er minute, fell t»- 
and the hearts a<-tion sfojjped a short time before r«'spiration 'Wtui nnspeudiiL 

.\irrnjtsif ithni' Innirn tiftrr timth ). - IJody that of an adult white male.la^ 
develiijMM! and vi-ry corpulent. Ab^^i-ncc nf pi >st -mortem rigidity, Imt fsoiueffi 
in^ pnsent. MiMlian inci-iion reveals a thick hiyer of subcutantHUiM fat. 
ojM-nin:^ the chest c;ivity th«' lun^rs wi-n* found to U* in a st.atf> of h^'postatic'i 
>^e>ti«.n at tin- ba>e-,. 1*1 uriiii' adhesinns invnlvc«l th«» lelt lower li>be. Wri 
nf luuL's: lii-ft. vlo ;<rams: ri^ht. iilM» j,'ranis. Hejirt a] >parently normal; vnii 
liH KJ'anis. The kidneys were slightly fatty, the cortex being: diniinMhe! 
thickness. Wei;,dit of or^Jins: Ticft. Ino ki'«i»iis: riKht. lJM)Kram8. Spleen VW 
:{]n ^rams aiul was n(»nnal. Pancreas normal: weight. UO grains. Thelivtr 
fatty: weij;ht. 'I.'-VM) j^rams. Stomach and intestines noi-mal. Meninges * 
marki-<lly oMlcmatnus. the serous effusinn <listen<led thtJ Hul>arac?hnoid fp 
(lilatimi the ventricles. Th" dura w.is siron«rly adlu'rent: woight of organ. 
j^rains. 

F. J.T 
H. VT. 

PARALYSIS. IIKMI1M.K(JIA. 

('. W.: a^'e, ■;!: naiivily. ^lissisvipj.j: j.dniilt.-d to the I'nitt^l States M.i 
Ilnspital. New ( Mlt-ari-.. I.ji.. January .'•. I'.nji: died January 11 . HIOI, 

///n/ji///.— I'ntirnt siatis that twiMity y«;jrs jjl'-o he had a chaiiere that \ra> 
lulh»wid l>y eru]»tinn: >in<-e then he h.is h.-sd ]»neuniiinia. smallpox, and gtmorr 
1 ln' latter three timt's. Ten years mlto he was ^Imt in the alKlomen, making a^ 

riH'iivi-rv ;ifli>r i iiiiT.'il ioU. 



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120 MAlilNK-HOSPITAL SERVICE. 

Pain extended down rif^fht leg to foot. Right leg began to get numb and havex 
feeling in it eleven days ago, Jind left six days ago. Hatl bad headaches ff»rpK 
two or three days. Api»etit^» poor. Incontinence of nrine and fecea. 

Phifsival r,va mi nation. — Gencjrjil condition iK>or; has large l>t»d sore on sacma. 
another on right hip, and .small ones ov<3r malleoli: heart and liin|?s negative: b* 
area of h>i)eresthesia. jnst above umbilicu.s. encircling ab<Iouien: below this aM 
and involving both lower limbs, has ansestliesia, the loss of sensation being afaoii^ 
total. Both lower linil>s are i)aralyze<l. Patellar reflexes lost. Paralysis of Wil- 
der and rectum mnscles. Atroplm; changes in both linihs marked. " Cntanft* 
circulation piX)r. 

Treatment, — Milk diet. Cathetorized morning and night. Dn^a wounds with 
zinc oxide. I* Elixir forri quin. et strych. et simj) hypophosph. Comp. aa part* 
equalem. M. signa: 5 c.c. t. i. d. Gentle mas.sage to lK)th limbH. 

May II, Iffoo. — Constipated: stop milk diet; l)ed sores liave become larger id: 
deeper and discharge (considerable pus; foul odor from them. Gnemas to rfbe^ 
bowels effectual. (:}^eneral condition worse; no psiin; has headaches; sleeps fiiiij 
well; has chills, fever, and sweats, whicli are (Controlled by quinine. 

June 11, lUuO. — Bed sores worse, de(»per. larger, and offensive. I>res^ed wic 
charcoal, beta naphthol, etc. General condition very i)oor; losinj< flesh: T^ 
rapid and feeble; liml)s. marked atrophi(»d: severe headaciies; complains of cram;'' 
like pains in aMomen: can't sleep; riglit pupil larger than left. 1^ Strychiik 
sulph., .002 every three hours. Jt* S«it. .sol. i)otass. iodide, gtt. JM) t- i. d. Pb& 
acetine to relieve lieadaches, and hy])notics. as .sulphonal, trional, and moipluBe. 
to produce sltjep. 

July y, Khjo. — Condition rapidly grew worse and, despite stimnlation, he died. 

Necropsy {eighteen hours after ditifh). — Body, male; aged about 60 yean: «• 
treniely emaciated; eyes glazed: riglit pupil dilated, left contracted; rigor nuvit 
well develoi)ed; slight suggillations in deiM?ndent portions of body; large and d*: 
bed8oreonbutto(^ks.exi>osingsa(rrum: anotlun* over left hip and others overexterofc 
condyle of left femur and (>v<*r both malleoli. Skull caj), normal; brain case.fkir 
size; sinuses and blo(»d vessels moderately tilled with blood; membranes, uormi 
Considerable serous fluid esca])ed on opt-ning into the cranial cavity. Brain wei^ 
1,510 grams; Vf'ssels congest^'d; considerable <iMlenm: cut section shows no giM 
lesion; anterior mtMliastinum. nnnnal: remains thymus gland, negative. Peri- 
cardium, normal ]>ositioii; smooth and glistening; contains about 50 c. c. of ckc 
serum. Heart (o])ened •/// sit u ) : Vent riches contain fluid bl(xxl; pulmonary yemi 
and aorta contain "(rliii-kiai-fat " dot: weight. 2*20 grams; aoilic orifice compe- 
tent according t^) hydrost.iitic test: valves negative: slight calcareoua depo^ntvii 
walls of aorta: mitral oritur^ small and valv<*s contain calcareous deposits in tl^ 
free border. La^ft plp\ira sIkiws numennis adhesions throughout to lung: rigte 
pleura the sjim«'. Lt^ft lung: \V«Mght, Too grams: floats, crepitates, and on ctf 
section shows considerable frothy sen nis exudate. Right lung: Weight, 4S0gnitt 
floats and crt?pitates: ])igm(*nted externally; (edematous. Great vessels ana nen* 
trunks of tliorax: Aorta in jisccnding and transvtTse portions shows coiisidenM^ 
calcareous dei>osit. Diaphragm normal. ( hnentum negative. Spleen: Weigiit 
190 grams; normal ]M)siti()n : cuts easily: cut section api)ears yellowisli and amenuc- 
Left kidney: Normal j position: weight. 100 grams: capsule nonadherent: cut8«- 
tion shows (listin<*t markings: curtex thiekiMied and yellowish in appeazwt- 
Right kidney: Shows same gross findings as left: weight, 166 grams: suprareml 
capsules normal. Ureters normal. Bladder: Mucons membrane ronghenol- 
thickem^d. and ("overedwith mu<M)-])iirul»'nt exudat(\ (renerative organs: Sevenl 
scarsonhead of iM:nis. Panereas normal. St«nnat"h normal. Duodenum noniiiL 
Gall bladder and <lucts nurnial. Liver: W«'ight. 1 .ToO grams: cuts easily; slight 
yellowish a])pearani-«* to nir si-ctioii. Large and small intestines normal. Spiitfl 
cord removed. an<l about 1 inr-li of flu* Inwrr ]>ortion of d«)rsal region was degen- 
erate^l: degeneration was tra]isv»'rs»'; rord in this section was smaller and softer 
than normally. Conl ])la<M'<l in Muller-: fluid. 

•I . JA, iv. 

CKHEIiUAL ni:M()RRlTA(}p:. 

J. M.: age,r>0; nativity, Russia: admitted io th»' I'nited St^'ites Marine HospitaL 
Baltimore. Md.. S(;pteni)M'r 17, VM){)\ dir«l S.-pteniber 21. 11M)0. 

Ilisfoi-ff. — Owing to ])atient*s nn-ntal ctnidition it was im]>ossible to obtaiDl 
clear history of his family. ]»revi«»us diseas»*s. or present illness, the only appxtiKi 
t4> the Mmio being tlie statement of \\w ea]>tain nf tlie ship f rom whK?h iMitleBt 
Clime, wlio stated that several days before the arrival of tin; vesstd in this porttto 



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114 MARINK-noSPITAI. SKRVICE. 

Ffliriiiiiii -^(. /.'""y,— IVimplaiiiu ut trpmnm unci pain in legs an<l »niui al nii^ 
T<rfltide IxfcamH liirKfi mi'l teinlt-r. Scnituiii ttiit^k uml (edematonf. 

Miirch in, /.'"W;.— AiMTiiiwilfiHtTilawiisfminil. tlinmgh wbich miint nf thuj 
escaped. Urind vitv nfFcuMivc. I'utioiit (^uiitinneA iu tbiu conditinu nntil ]liirl| 



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18, 1901: at tiinos he wouki hiiVM iin iiic-rcii*' i.i llii> ititensily of his Bjia] 
Conwtiiiation altf-niiiti''! \v\X\\ <liiirrln-ii nf a lilixuly nutun'. The liatnla in p 
reuiiiinetl.tit tiinemiiHt-hHrtfinBiiimniletit (Iniil. Aiiint;hiivrprtal lietnla 
fonsd. Patient at tiiuea tjoSerud fn>m btiuilaclipii. iiaiuiea. and Tomiting'. 



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116 MABINE-HOSPITAL SERVICB. 

Necropsy (thirty hours after dm fh ) . — Heiglit, 1 .75] meters: weight, 75 kiloB. Body 
is that of a well-nonrisheil white adult male. Rij^or mortis well marked. Sngjalls- 
tious fairly well marked all over th«^ body. Brain: Weight, 1.400 grams; shghtlj 
congested; otherwise normal. Spinal eord: Dura and cord normal in grossappear- 
ance. Pericardiiun normal. Heart: Weight, 890 grams. Aortic and puluioiuc 
valves normal in appearance. Heart muscle apparently normal. Liiings: Left, 
weight, 530 grams; crejntates. floats in water; apparently normal; right, weight 
760 grams; adherent to pleura and diaphragm: floats in water, crepitates: appar 
ently normal otherwi.se. Liver: Weight, 2,040 grams; normal in api^earance. 
Si)leen: Weight, 340 grams: normal in ap])earance. Left kidney: Weight. 1*' 
grams: capsule strips; on st^ctitm a quantitj' of purulent fluid found in the pelri? 
and ureter; x>elvis very much dilated; cortex diminished, a small, circumacriW 
abscess cavity found in the cortex; markings distinct. Right kidney: Weight. 
]X') grams; cortex thinned; pehis somewliat dilated; markings distinct. Bladder 
Walls extremely hyi)ertrophied; about 2 cm. thick: cavity very mnch lessened: 
cai)a<'ity reduced to alnnit 50 0. c.: contains a ])urulent fluid; inside of bladder 
sbows oi)enings of a uuiuImt of fistulie: one <)i>ening into the rectum. 

L. S. S. 
C\ W. V 
J. M. \l 

(iAMMATOrs TTMOii OF TUK HHAIN. 

J. J.; admitted to the United States Marint? Hospital. Stapleton, Stateu klan-l 
September IH, liMK); age, 37; nativity, Xorwav: la.st emi)loved on schooner Gnwi^ 
I). Chambers: died May 11), 1001. 

History. — Tlie i^atient entered the hospital formerly March. 2, 19<K). m 
remained imder treatment at that time until Septeml)er IT, 1900, thie diagnoc^ 
lieing syphilis. His most consjucuous symx^tom at the first wjis intense headache., 
principally on the right side, but shifting, and occasionally entirely alment fori 
day or so. He also liad i)ains in the feet and h'gs. Gait was ataxic. PupD 
reacted to light and ac^commodation, but the right was narrower than thelef".. 
The x)atellar reflexes wen* al )scnt. There was no evidence of anestliesia ani'whm. 
There were no clear external signs of syiihilis. He gave a history of having hii 
venereal disease about fifteen years i)reviou8ly. Treatment had np perceptiK? 
effect in checking the slow i»r«)gress of the di»<ea>e, which was characterize<l bj 
loss of nervous jMAver. in the mental and motor systems particularly. Visicc 
failed also, and the com] )h lints of pain in head and feet were more or less constant 
The i)atient was abst»nt only ontj day fr«)m the hospital, when dischar^d inSej- 
teml)er. His condition i>rogressed steadily, until at the last ho was conipletrij 
helpless, d<*monted, and blind. The symiitoiiis by which a tumor of the hiai= 
could have l»e«'n diagnosed and itsjMisition definitely located were never clear, aod 
there was much cause for l)eli(?ving that the ataxic sympt<^ms were due t<»«i 
aflfet^tion of the spinal cord. The patient died in como, having had a nnmhtirof 
similar si)ells i)reviously, which lasted only briefly. 

yeeropsy {si.r hours after dcatti). — Body well n<mrished and muscular. Port- 
mortem li\idity and rigidity of d«^'i)endent parts m^nlerately developed. Papib 
mcKlerately and evenly dilated. Rii^ht little finger missing. Two suisill ulcen 
over internal mall«^)lus, extending deeply into the sldn. Kpidermis of ri^ht heri 
loosened, sho^ving red derma beneath. Skullcap tlnii. Meningeal vessels foil <tf 
dark, fluid blood. Sui)erfieial vessels of brain cnntaine<l dark, fluid blood. A 
tumor was found in the brain <'ase a]M)V(< the tentorium ('f^relK'Hi, compressing tl^ 
cerel>ellum and i)ons and the occi]ntal lobes of the brain. The left occipital lobr 
was greatly thinned, the surface markiii^^s and gray cortex iK'ing obliterated on 
the median surface. The right 1o)m» was compressed to a less extent. The tninor 
lay al)out two-tliirds to the left and (►ne-third to the right of the median line, ft 
weighe<l 'J'JO grams and was nearly tlie size of tin? closed fist. It w^is finnlr 
adherent to the dura, but not to the brain tissu(». Its consistence was firm uii 
the surface niwlular. The bone ovt-r tin* tumor was enwled and so thin as to 1* 
translucent. The great longitudinal sinus was oblitei-ated completely where it 
XKissed over the tumor. The cut surface of the tumor ai)X)eared fibrous and li*4 
an arbores<*ent arrangement: it cut with difficulty. A si)ecimen about 15 cbl 
long of the s])inal cord x»resent.<'d no x)Ositive gross lesions. On oi)ening^ abdoma 
subcutaneous lat was found in good ([uantity. The skeletal muscles Tfere laiff 
and <lark <'olored. Pericardium contained a small annnint of clear serum. Hcttt 
ha<l consideniblc fat on surface: wciglit, IHO grams. Ojiened in 9itu, Left 
ventricle contract^^d. Right ventricle contained cl«)tted blood. MitXBl Vtlrt 
a<huitted two finger tix>s: tricusx>id two fingers entire. Aortic and polniansif 



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lis MARINK-HOSPITAL 8ERVICK. 

ALC^onoLISM— DELIRIUM TREMENS— CEDEM A OF THI 

J. \i.: af^<*. :W: luitivitv. New .li«rst'v: iuliuitt^l l<» tin? l'iiit»*«l 
Ilospitjil. Cliirago. 111., (iftolM-r 1:5, 1J«)0: dit'd ()ctol>er L*<S, l!K)n. 

Ilisttn'if. — Two years a^o ])atieTit experienred an attmrk <»f piie: 
iinnitli a;;(» lu; was subjected t<» ex])«>siire in a severe Btoriii at sea. 
his feet and l«'^s were <lreiK'hed. Sonn alterwards his extremities V 
and i)aiiis and eraini>s in tlie j^astr<M'iiemii luuwleH d«»vt»l«ij)eil. ' 
there was a sujM'rli<'ial trauniatii* ulceration on tho ri^ilit 1 k- *"id ' 
Hwr>llen and < edematous to the knees. Fre<inent and iHiinful iiriiiat 
tressinvc symptom, the t>nM.*t of which dated from tin* (^x]M>Hiirt: 
Motion of the joints caus^'d jMiin after a total al>stiiieiu*t* €*f two y\ 
had l)een drinkin;^ excessively for three wet»ks prior to adiiiisftioiiaii 
jdete anorexia, insomnia, and a coiirse muscular treiiKir. His nv 
The ]ndse was I'iO. full and lN>unding. TeuiiK»niture iiomial, and 
throuj^lniut illness. The urine contained a ilocnlentflediiueiit. u trat 
and a f«*w hyaline and granular ( asts: s])ermatozoa were prt»8.^nt in hi 
also calcium oxalate crystals, round cell-d einthelium, and mis cell 
ment consisted of exclusive milk diet, an initial imrjre witli lum» iiia.«h 
ca])sicum m. x t. i, d.. and cliloral hydratii 1 gram, with potass, brc 
(rvery four liours as nocressiiry to in<luce sh'ej). 

Ortoht^r Jfi. — Patient became cxtnMuely nervous and doveli>i>e<l 1 
and delusions of various sort<. The use of hypnotics prodnoed litt 
s(M)n as ]>atient ('lo^^♦•d his <'yes he wiw various objects, prin<'i|>ally 
nials, funerals, snakes, etc. 1! wliisky 'M) c. e, and tr. di^talis ni. x 

Ortohrr /,v.--The pwelliuK <>f the h-^^^s entirely disiippcared. The 
hail })i'Come feeble, improve<l under tlje above stimulation, bnt pt 
delirious and t<»n^ue was tromulous ami heavily furre«l. 

(h'tithcr:". —Patient requir^-d r<'straint to keep him in ]>e<l. He t<ii 
U'd clothing; and had a muttering delirium. Whisky and caiMicuui 

(h'fninr ..'.'.--Stui»or d«'velo])ed. The resj)iratory muruiur wiui fonn 
ovrr the bases (»f the lunt^s, and <lullness jm'vailed in the same rt*giii 
nium carbonate. 0.0 t. i. d. 

Orfuhrr ;.'.',.- -There w;is (-ouirli with tenacious nmeous ex|>ectorati4 
and excessive tremor: dee]) stujior: breath excessively offensive. 
iu'tirui was feeble and ]>ati<'nt had incnntinence of urine. Qainokc 
s])inal canal lM*tw«^'n third and fourtli dorsiil vertebne resulted ne^ 

OvttAur :i:. — The pulse rate, whi<-h had reiiched to HiO iH*r mint 
an<l the heart s action .stopped a slu>rt time Ix'foro respiration ^vas sn 

Xrrntffsif ( fhn «' fnnnH itf'fi r firnih ). -Body that (»f an adult whit** 
developed and very cnrpulent. Absi'n<'e of ]»ost-mortcm rijodity, i>r 
in;^ liri'M'Ut. Median ineision reveals a thick layer of snlHtiitane 
oiM'uiiiLC the chest ca\ity the lunirs w^'p" fi)uncl to be in a state of lij 
j^e>tinn at the base's. 1^1 -uriti.* adhesions involved the left lower It 
iifhniLis: Left, -'To ^rams: riKht. '^*!m) j^rams. Heart apiwirently nor 
470 ^rams. Tln^ kidneys wen* sli^litly fatty, the cortex beings d 
thickness. Wt-'i^ht of orj^ans: Left, I so grains: ri^ht, lOO^ranis. Si 
:»lo ^rams and was nonnal. PaiK'n-nsnormal: wei^dit. I4()>craniH. 
fatty: weij^ht. *.',:itM) •rnims. Stnma<-li and intestines normal. M( 
markedly (edematous, tlie serous elTusion distended the snliarac 
dilatini: the ventricles. Tin* dura was ^iron;<ly adherent; ^vei|fht < 
j^rams. 




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120 MAKi:^K-HUSPITAL SEKVIOK. 

Pain fxtf-nded down ri;<ht le^ to fo(»t. Right log l>egan to get numb and ha 
f<^ling in it eleven days ag«>. and left six days ago. Had Imd headaches foi 
two or thn.MMlayH. ApiM-'tite iMx»r. Inoontinenre of urine and feces. 

I'hijHh'ttl t'.rtt mi nation. — G(?neral ctmdition ptjor: has liirge IhmI sore on sac 
another on right hip, and small ones over nialle«>li: heart and lun^ ueja^tive 
area of hviJeresthesia. just tibove umbilints. encircling alHlomen; l>el<>w this 
and involving lx>th lower limits, has amestliesia. tht; loss of Bensation being a] 
t<ital. B^>th lower limUs are paralyze<l. Patellar reflexes lost. Paralysis of 
der and r(*ctnm muscles. Atrophic changes in lK)th liui]>s marked. * Cutai 
circulation prxir. 

Treatment — Milk diet. Catheteriz«Ml morning and night. Dress \vonnds 
zinc oxide. I* Elixir ferri quin. et strych. vX simp hyix)phosph. Conii>. im pa 
equalem. M. Higna: 5 (\c. t. i. d. Gentle massage to l)oth limbs. 

May 11, litfHt. — Constipated; stoi) milk diet; l>ed sores have l)ecome large: 
deeper and dis<;hargo coiLsiderable pus; foul rnlor from them. Eueiuad to n 
bo welH effectual. General condition worse; no i)ain; has headaches: slee^ts J 
well; has chilLs, fever, and sweats, which are controlled by quinine. 

June i/, lUot). — Bed sores worse, deepi»r. larger, and offensive. Dres>ed 
charcoal, Ixjta naphthol, etc. General condition vi?ry poor; lo.siii^ flesh; 
rapid and feeble; limbs, marked atrophied: severe heiuliuAies; complains of cr 
like i>ains in alxlomen; cant sleep; riglit pupil larger than left. Up Stry< 
Bulpn., .^X)2 every three hr>urs. Ijl Siit. sol. iK)tass. iodide, gtt. 80 t. i. d. I 
acetine t^) relieve headaches, and hjiniotics. as sulphonal, trional. and morp 
to produce 8le<;p. 

July /, i:ton. — Condition rapidly grew worse and, despite stimulation, he d 

NerropHi/ {eighti'en himrtt aftrr drath). — Body, male; aged about 50 years 
tremely emaciated: eyes glazed; right i)upil dilated, left contnicted; rigor u 
well develoi)e<l; slight suggillations in deiwiideut portions of lM)dy; lar^^ and 
IxmI sore on Ijuttocks.exjM ising sacrum ; another over left hip and others overext 
condyle of left femur and ovj-r l)oth malleoli. Skull ca]), normal; brain cast 
Hize; Hiinisi's and ]>hHKl vessels moderately filled with blood; niembraneB. no) 
Omsiderable wrous liui<l e>ca]MMl on (»iK'ning into the cnniial cavity. Brain w 
1,510 grams: vessels congest^'d; considerable (edema; cut section sho'ws no . 
lesicm; anterior mcnliastinum. normal; remains thymus gland, nej^ative. 
cardium, normal ]K»sition; smjK)th au<l glisti'iiing; contains aliout 50 c. e. of 
serum. Heart (oi)ened /// situ ) : Ventrich's contain fluid blood; pulmonary vi 
and SLiyrta, contain " c]iick<*n-fat " clot; w(?ight. 2*-30 grams; aortic orifice co 
tent lUM'ording to hydrostatic t<*st: valves negative: slight calcareous deiKN? 
walls of a<jrta; mitral orifice^ small and valves contain calcareous de{>osits i 
freel)order. Left pleur.i shows numerous adhesions throughout to lung; 
pleura the sann*. Left lung: Weight, TOO grams; floats, crepitates, and oi 
section shows considerable f n )tliy senaisexudat^e. Right lung: ^Veight, 420 gi 
floats and crejntates; ])ignient4Ml ext«*nially; (edematous. Great vessels and ] 
trunks of thorax: Aorta in asceinling and transverse i)ortion8 shows conside 
calcareous deiMJsit. I)iai»hragm normal. Omentum negative. Spleen: "W€ 
190 grams; normal iwisition ; cuts easily; cut section apii(:»ars yellowish and ana 
Left kidney: Normal ])ositi(ai; weight. IIH) grams; capsule nonadherent: en 
tion shows distinct markings; c«»rt('X thickened and yellowish in appear 
Right kidney: Sliows sam«» gross findings as left; weight, 166 grams; supra 
capsules normal. UrctiM's nonnal. Bladder: Mucous membrane roughi 
thickened, and cov(*rcd with muc<)- purulent exudate. Generative orgfansrSe 
sciirsonhcad of penis. PaiuTeas normal. Stoniacli normal. Duodenum noi 
(tall blad<l«T an<l ducts normal. Liver: W«Mght, l.?.")!) grams: (nits easily; b 
yellowi-^h ai>p«'arant'»' to rnt s<-rti<>n. Lar;<«» and small intestines normal. S 
cord removiMl, and abont I inch of the Inwcr ])orti«ni of dorsiil region was d( 
erated; degeneration w.is transviTse; ci>rd in this section was smaller and 8 
than n<»rmallv. Cord plac<'«l in Mnlli*r"s ihiid. 

J. M. 

CKHEnilAL TIKMOHUHAGE. 

J. M.; age.."»0; nativity. Russia: admitted to the United States Marine Hon 
Baltimore. Md.. S-i>teni)n-r i:, liHio: ib,.d Si^pteniber 21, 1000. ^ 

llistiH'ff. — Owing to i»atient's mental condition it was impossible to obi 
clear history of his family. ])rfvions dis»'ases. or present illness, the only Mpi 
t4)the.sjime l>einjj: tlie statement of th<» captain (»f th(* ship from wfaush pa 
came, who state<l thatsevt»ral days lM'fi>re th«' arrival of the vessel in thifliS 



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122 MARINE-HOSPITAL SERVICE. 

October 14. — Patient is resting somewhat better. Tumor is iiitich m 
nent and by giving away anteriorly has relieved the pressnre, cansing : 
symptoms. 

Ovtobtr 2.i. — Patient resting fairly w(;ll. Complains of weakness. 

October <iJ. — Patient slept very littl(» during the night. Coug:he<l coi 
Tumor shows no niarkt^d increjise in size. 

Xovrmher 4. — Cough troubles patient very much, l)einf^ Hlmotst ince» 

Xorember .'7. /,v/y.'/. — Tumor has increased in size and soreness. Has 
phia every night for some time: sometimes two tablets during the 
each. From this date until the date of his death the patient siiffertnl 
witli smothering and coughing, which was relieved only by the use oi 
Since Octol)er 9, 1899. he has hiwl 7.") c. c. of whisky daily. 

Jonuartf /i^ 7.W/.— Post-mortem exaniinati:)n. two hours after death: 
showed man of medium size: body gn^atly emaciated. Pear-shape<l t 
tru<les through what was the manubrium, to a height of 3 iuclies alH)V( 
of the sternum; this juts into the space iKjtw^H-n the clavicles and exte 
ward for 5 inches. The skin was removed from the thorax and the 
through 3 inches from sternum. The sttTnum was then renioveil by di 
free from the aneurism: also the i)ericardium and pleura, l>oth of w 
intimately adherent. This brought into view a large tumor, l>eing t 
lK)rtiou of the aortic arch. This dilatiitinn was almost entirely filled v 
of coagulated and organized fibrin. Tlie first 2 inches of the aorta w; 
at this point the dilatiition commenced and extended through the c 
I)orti(m of the aorta to a level with tlie sixth dorsal vertebra. The ca 
emptied of the laminated clot formed by the organized fibrin vfsls 6 u 
and 34^ inches in diameter. The aneurism had eroded the entire luauu 
the upper 1 inch of the gladiolus: also tlie sternal end of the right first 
tratrhea was deflected to the right from its normal course and attac*hed 
side of the aneurism. The i)ericardium was distended with 150 c. < 
yellow serum. The heart was pale and flabby. Right luugr nonadl] 
contained scattered masses of caseous tubercular deposits. Tim left 
cfmijdetely adherent to the ("best wall and filled with caseous and pu 
Trachea w.is fill<*d with thin ])urulent material. The imtient liaving ha 
s>Tni»toms than those recorded, and having died of starvation, there "w» 
sity for niiUdng further examination. 

( 
1 

ANEURLSIM (SACCULAR), TRANSVERSE AORTA. 

W. A.; age. 39 ye^irs: colonel: nativity. Missouri: admitted to theU. 
Hospital, St. Louis. M«».. Auirust JJ. 1990: died Octol»er ::>7. 1900. 

Fa mill/ hist on/. — Mother died of i)Tieumonia. Father and one 1nx>ther 
cause unknowni . 

Personal hist or//. — Had measles and whooping (;ough during^ childhooi 
and gonorrhea in early manlKKjd, also sj^jhilis. At present comptain 
in ch<'>t and shoulder and of a ba<l cold. 




r, . --' J^^^Piiator; 

rough and wavy. Expirati« >n ]>roloiiged and rough, e.si>ecially on left si( 
nosis. tul>-rcle of lung. Troatmnit. su]»i)ortiv(» and tonic. Dischar^ied ] 
v.). IMiT. impr<>V(Ml. Rcadniitt«Ml to ]i<»spital .Tannary 3. 1000. Con 
])ains all over chest, an«l dysjnio'a and ])al]>itation of heart. Has some 
sonic swi'ats at night. H(av«'ls regular and ax>i)i'tite poor. Has dig! 
Kxaniination reveals a iMiIsatiiig tumor in second intercostal space, abon 
toleft<»f sternum, giving distinct bruit. Left radial pulse not as full 
Systolic murmur at aorti«' valve. Diagnosis, aneurism of tnmsrei 
Treatment, indide of ]>otas^iuni in imreasinir doses. Strychnine gr. 1 
Codeine andi)lienaeetin p. r. n. Dischargrd June-1. 1900, improved. Bi 
Augu>t 2'i. 11H)(». eoiiiplaining of same trou]>le as alH)ve. Gives history 
a weight and f«'eling excruciaiiTig i)ain in lack just below lo\7er bon 
si'ajmla. and of a sensjitiou as of someiliing giving way. Spits up b 
examination find dullness over entin* l<'ft side of chest and resniiaAa 



diminislied on left si<le and increasrd on riglit. (V)m]dain8 constant] 
an<l hy|H)dermic injtH'tions of iiiori>hia necressjiry at frenuent inteiTSI 

m»nt supportive and to relieve pain. Deatli occurred on the 

27, lUUO. 



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124 MARINK-HOSriTAL SERVICE. 

widening ont almost horizontally Uy the nipple, then ciirvinK'do'wn q 
rally to the diaphnigni. Cardiac pulsation unusually plain to eye. 
examination negative. Ho (complained often that food ])aa8ed part wa 
ach. then remained some minutes, and later slowly x)assed on, or at time 
tated. Pain continue<l almost constant except when relieved by c<xlein. 
of pain mainly in back, left thigh, occasionally in left testicle, nu> 
shoulder. Rounded pulsating tumor appeared in epigastrium and c^ 
increased in size. Temjwrature was 'il to JJ7.5 in the morning an<l 37 
the evening. Pulse varied from 85 to 100. Dec^imlxT 1.*}, at H.40 p. u 
tasted blocxi and callfKl for nurse. A moment later he began raising bio 
ful after mouthful until it amounted to about a ])int. Pulso grow 
feeble. Soon he became comatose and no mon? bhxxl escaped froi 
Abdomen lx?came swollen and tympanitic. Death ensued in twenty-fiv< 
Necropsy {tirrntif-six fttxirs after drath). — Body emaciated. Amlou 
what distended. Rig( )r mortis present. Abdomen ojiened first, contiiiin 
serum. Stomach greatly distended with fluid. Other viscera apparent! 
Thorax opened. Clear serum, 2.S00 c. c. in left pleural cavity and 2 
right. Viscera removed after tying all vessels. Left lung weighed 195 \ 
right 528 grams. Left lung compressed, creintant only througfh upp 
upper lol^; right lung crepitant throughout, cedema in lower lobe. A 
tion of trachea one calcified IjTuph gland found. Pericardium contain 
clear serum. No adhesion in pleura? or i)ericardium. Heart weighed ij 
Valves competent. Slight evidence of atheroma. Stomach measured 
shorter curvature and iSi\ cm. on longer, and was 40 cm. in circumfere 
its middle. It contained 1 .U50 c. c. of dots and fluid blood. The live 
2,040 grams and was of normal appearance externally and on section. T 
weighed 290 grams, was 20 cm. long, 10 cm. wide, and 2.5 cm. thicl 
thickened, pulp firm, dark red. Intestines negative; pancreas the san 
removal of the al)ove viscera oxce])t the heart, the diai)hragni ^was cnt 
erally. The heart, aorta, and b(*ginnings of thoracic branches "were <lift 
and the alxlominal aorta from the iliai^s upward. The spinal ci>lumn 
through above the eighth ril)and through the fourth lumlmr vertebra ai 
from the eighth down, and the whole mass was then removecl, includin 
neys in situ. A large fluctuating tumor luwl alrefuly been felt in front i 
tebne lx)th from above and from Ik'Iow the diaphnigm. After removal 
was alx)ut 20 cm. long from alK)ve downward, 15 cm. wide, and 9 to 10 
The sac was filh-d with l)lood clot. Examination showed a division : 
parts. The original sac. 15} (tm. from above down by 5 cm. in diameter 
the anterior iM)rti<m, and is indicated in the photograi)h by the adjoinii 
the two canulas marked f f f, the upper *'f " being an artificial oi^enin 
arch of siortii and the lowest *'f " a similar opening at bifurcation of i 
aorta. The canula "n" passers (just above this letter) into the coeliac^ a 
was much dilated and was the lowest point of the aneurismal enl 
Canula **k k" pju'^ses through the sui)erior mesenteric! arttTy, which "wbs : 
ently enlarged. Burrowing from the original sac w^as another to the 
upper i)art, which nu'asured 7 to h cin. long and 5 cm. in diameter. T 
agus ran just p(»sterior to this, and at the dei'i)e8t i>art of this sac "wi 
rupture into the a*soi)hagus. This explained the hemoptysis on night 
the sudden distension of alMlomen. and the bl<K>d found later in thestomj 
situation of tliis siic also explained the difficulty in swallowing and the « 
regurgitation of liciuid food. The canula "g g" passes through the "wh 
of (I'sophagus as dissf^ctecl out, wiiile " h h" is a curved canma passini 
the mptun? in sju.' and down th«' (rsopliagus to point where cut jturt ab 
ach. The X)oint of rnpturi' was too deep to V)e shown in photograph, p 
middle cf original sac was the? tliird, wliich contained tlie dissected out i 
enxh'd vertebrie, the last two dor>al and first two lumbar, and which l ^ i 
the ri))s on the Irft and occasioned \]\v f«'<'ling of fluctuation at npper t 
I)soas inu>«'le while sac and diajJiragni were intact. This vertelwij. i 
cm. long from al>>vc down, lo cni. wide. an<l 7 cm. deep. 

VALVULAR DISEASi: OF HEART. 

Ilritjh t's itis('as<\ 

S. M. (colored): age, i>^: nativity, Alabama; was mlmitted to TJnl 
Marine Hospital March (J, IIM)1: died June 11. 11)01. 

Iltstorif. — Four years ago had an attiU'k of fever. ])resumably" two1^ |i| 
having had anv venereal disease. Was treated in this hospital two v^ 



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126 MARINP>HOSPITAL SERVICE. 

Jnne 2. liyiMKlermicfl of Magendie's solution of luorjiliia were given to allay es 
ment. June :i. Htimulants were Kivt-n. but at 2.:J() a. m., next day. he died qui 
yrcrojtsi/ (nine Ikhi is after dntth). — B^kIv that of a well-iionriHlied. inu-'«ti 
adult male 1 .05 m. in leuKtli : <*adaveric rij^idity well marked: suKK^^^'^^i^^i^^ P^ 
in ui>i>er extn^mity, none in lowt-r: jrroat (edema of lower extremities. B: 
Weight, 1.470 grams: dura n(»t adherent, subdural si>aee contains t?00 c, c. *>€ 
fluid. Heart: /// ttffn heart enlarged to l<*ft and downward, though sliglith 
vated by diaphragm. Weight, T50 grams. Right side of heart full of blood: 
tains a large post-mortem clot: post-mortem clots in all the great vessels. ( 
nary sinus congested. The aortii contJiins an ant^-mortem clot. The right au 
contiiins a large ante-mortem clot. The aortic valve is incompetent by h> 
Htati(; test; segments shrunken, and sclerotic, witli atheromatous plates ari 
root of aorfci: wall of aorta hyi)ertrophied. The wall of the left ventricle si 
hyiH»rtrophic dilatation. The mitral valve is shrunken and thinned: the 
auricle is dilated and hyix»rtro])hied. The pulmonarj' valves are tliinnetl; 
right v(»ntrirle shows hyi)f rtro]>hic dilatation. The tricusjdd valve is transpai 
the edg<?8 being worn thin: tlie right auricle is dilated. Lungs: Weight, left 
grams, right H2() grams: float on water: marked congestion and <edema, < 
cially in lower lolx's. Right lung adherent at biise and to i>ericardinni. L: 
Weight. *J,0<K) grams: nodulated: c(mnective tissue in excess; nntuieg appear 
on section. Spleen: Weight l.io grams: cirrhotic: indulated; ca])sule ailhei 
Kidneys: Weight, right 2:^7 grams, left *2'20 grams. Lobulated; capsnle at 
eut; interstitial tissue in excess. Fattv degeneration of pyamids. 

J. N. I 
C. W. 
J. M. ( 
AtH'tic (tnti tuitral. 

ir. J.; age, 59 years; nativity. Arkansas: adniittiMl to Unit<»d St^ites Mi 
Hosjntid NovenilM»r 2:J. liMH); died Novemlier 24. 1JM)(). 

///.s/o;-//. — Patient denies haWng had syphilis or rheumatism; ^vas first t; 
sick al)out two wet'ks prior to a<lmission. On admission dyspiuxja was mar 
sleeping was difficult ex('e])t in sitting ])osition: cough slight; ankles and feet< 
matous. On physical cxaminati* )n the heart was found to be enlarged Tvith sys 
murmurs audible at lK)th bast; and a]M*x: ajx'x displaced to left and downv 
area of liver dullness ("onsiderably enlarged: sph^m not enlarged. 

Xcmtjjsff {t went If hours a/trr (ht^tli ) . — Body well nourished; ankles and scrn 
(edematous; rigor mortis ])resent. Brain: Weight, 1.5370 grams: old 1< 
miMiingitis over vertex ahrng longitudinal fissure, the membranes "being fii 
rent to e( ' "" " "" * - -r^ ^ - . . 

iglit side: 
ty slightly _. 

roughencMl and opening enlarged: mitral leaflets a^iparently normiJ. bnt ope 
enlarged admits thre(» fingers; aorta f(>r first inch or two thickened and call 
ons. Lungs both sliow hypostatic congestion and pleuritic adhesions; right! 
he])jitiz«»d at l)ase: Weight, left lung, (WiO grams; right 1 . 1 50 grams. Liver enls 
and congested : Weight, t?. 1 70 grams; gall bladder moderately full. Spleen nor 
Weight, yoi) grams. Kidneys normal: Weight, left, 220 grams; right, 290 gr 

a. u. 

Milrul. 

A. P.: age, 50: <'ol<>r«?d: nativitv, Kentucky; admitted to United States III 
Hosjiital, St. Louis, Mo.. I^lay 1){,*11I01: die(r.lnne5. 11K)1. 

///.s/o/'//. -The i)atient first came to the hos]»ital April 12, 1900, and "WM 
charged impr»)ve(l April 17, 1*.hh). He was also in this hospital from Joly 88 ! 
to August 'JO, ltM)0, from Febrnarv 5, 1J»01. to February 2:J, 1901, from Mn 
llMH.to April 12, ItHM.and from May V.\. 1001. to June 5, UK)!, the dateot 
deatli. On all these occasicnis he suffered from symi)toms due to the ^*m 
condition of the mitral valve, lie stated that lu* had an attack of rhemnatil 
1S71 which lasted ten days, and that he had had .slight rheumatic pains eversi 
He had never had a venereal sore, but had had gonorrhea several times. A1 
relatives wen* dead and he did not know what disease had canned the dflSl 
his ]mn'nts. The sym]»toms which troubhMl him most was dyspncBS* H 
iH'gan alxiut tifteen days befon» In* tirst came to the hospital. He also hadad 
cougli and (K'casionally ]>ains in his chest and alidomen. He had had tllS O 
every "winter f < »r six or 8t> ven years. 



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128 MARINE-HOSriTAIi 8EKVI0E. 

VALVULAR HEART DISEASE. 

J. S.; ago, 54: nativity, Scotlaud: a<lmitt«Ml t^) UiiIUkI St^tt.^s Murine H< 
at Staploton, port of N<*w York, N. Y., January IS. l',K)l; d\o<\ Jaiiuar>' }■') 

Height, 5 foet (\ inches: weiglit, HiO ponnds. 

Fnnn'hf hisf(n-y. — Most members of family long-lived. Father suffereil 
from rheumatism. One brother died of miliary tubercnloRis. 

PrrrinHs sichm'si*. — Had t^ihoid fever yearn ago, also au attack of gone 
Has used alcohol and tobacco. Patient has been in this hospital ten tin« 
first three for rheumatism, and the last seven for heart diAoase and rheuiu 
In NovemlKT. 189S, he came here witli s\Tnptoma of heart disease of three 
duration, consisting of shoi-tness of breath, edema of extreiiiitiea, rough, ai 
turbed stomach. During his stay h»' had (M-casional slight rlieiiinatic atta 
various joints. The cardiac signs were tlien descrilKxl as enlargement, and 
systolic murmur at the a])ex, loud and hK'alized. There w^ere at first si 
pnlmonarv congestion and albuminuria, these later subsidinj^:. There wei 
signs of i)ieurisy. Aft^-r a stay of two months he was able to pro ont. Tt 
cessivo visits r«'semble the first, differing only in the severity <.>f the s>Tn] 
Under rest and ai>proi)riat<» medic^ition coni]H'nsjitinn l>ec^ame reestAhlisliH 
to fail again on tlit^ resumption of active life. At a physical examinatioi] 
October, lO(K), th(i heart was found enormously ♦•nlargixl. its action exti 
irregular; then* was a lou<l iriitral murmur occupving the second Bound and s 
aortic^ murmur of indeterminable <M'cunvnce witli reference to the sounds, 
of an old pleurisy were found on the right side of the chest, and even Bom« 
elTusion was sus])ected. although no fluid was obtivined ni>oii aspiration, 
nrino was but slightly albumiiu )us and no casts were present. There was ea 
dropsy, ccmgh, dys])n<ea. and gastri»' disturbance. 

UjMm leaving lierf, at his re<iuest, on January 7, 1001, lie -was "wnmed as 
danger of his attempting hard work again. 

When brt)ught to the hospital in the ambulance the last time, Jannnry 
ccmdition was vt^ry bad: he was a]»parently in extremis. There 'was gTe«t > 
of the legs, orthopniea, enormous distention of the (cervical vessels and cys 
Blo«Hly mucus was coughed uj) at int^^rvals. The heart was apparently 
eidarged and its ac-tion was very irregular. Ti>-and-fro mnnnnrs "were every 
audible, ami imlsations at the wrist did not corres|M>nd to the heart beats.* 
few of th(j latter reaching it. Tender the influence of rest he improved si 
for a few days, then wmk into a stuporous condition, cyanosis increased 
blo(Ml was coughed up but not exi)ell«*d from the mouth, catheterization b 
necessjiiy. and he died without regaining consciousness. His muscular ai 
pos«' tissues did not suffer much. Th«»r(? was no ft^ver during his last stay. 

Medication was 8ym])tnmatic and the emidoyment of such remedies as dij 
stroidianthus. si)artein. nitroglycerin, salicylic acid, jiotassinzQ iodide, elat< 
etc.. when indi<*ated. 

AVc/7>;;«// ( thirtu Jumrs itffrr drath). — B<Mly that of a male, apparently ab 
years of age. Rigor and post-mortem lividity'])resent: body "well aoarishc 
muscular; xmpils evt>nly and mtMlerately dilati-d: legs somewhat edematoaf 
incision considerable sulKMitaneous fat found: skeletal muscles 'Well develop! 
of a dark color. Mediastinum, (rreat increase of area ocx^npied by the hett 
abnormal separation of the anterior edges of the lungs. Thymus remaiz 
found. PHri<'ardium contains an abnormal amount of clear yello^r senv 
surface* is smootli and white. Heart is v<.'ry large. OrM'ned in situ and boti 
tricles found to be dilated, tin* rii^ht v»'ry markedly. The right ventricle ooi 
fluid and cl«)tted bli»od. the left is jn-aetically eni]>t.y. On removing the hean 
the aorti<' an<l tli" pulmonary valves are l'oun«l insufficient to thehydroetati 
The right auricnlo-ventricnlar«>riHee admits tlire(? fingers easily; theinitnl< 
barely admits one finger, is of <-resce]itic sliai>e,anil is narrowed hythecontn 
and adhesion of the valve leafh'ts. Thi* leaMelsof the aortic valve are much 
ened. thr)se of tile ]Julmonary aTid tri<-uspitl valves to a less extent, and tb 
the iriitral valve enormously thickenid and the seat of numerous f»a V?t 
deposits. My«H'anlium. ojM'cially of th«' right ventricle, much reduced in' 
ness. Heart weighs y.») grams. r^»lt jjlenral <'avity is freo*from abnormal 
or adhesions. Kiglit i>lenral cavity is almost entirely obliterated by oldadhe 
Thelu7igsresemble<;aehotlier in being<'dematt)usand congested, Hoatinffim 
and exuding frf>thy bhxxl and serum from the cut surface. Omentum cont 
large amount of fat. Sjileen w«.'ighs '240 grams: is firm and dark colorad. 

kidney weifrhs 'J to grams, is firm, cuts a lit tl(> liard . and ])n>sents on cnt aectiaBJ 
surface with fairly di.stinct markings, light-colored strijo b<nng visible In thi 
mids, and the corte:^ of nearly normal thickness. Right kidney wei^uHQi 



\i;i\» it.i-i'i I \t -t I!'. I. I 



■ I I. .r- 'till .1 ••! i..H.'' i.~ ".-■' 

^I.>.l<>.il.i),fnr'.i.r'- l<(ti:'>! 







122 MABINE-HOSPITAL SERVICE. 

October 14. — Patient is resting somewhat better. Tumor is much 
nent and by giving away anteriorly has relieved the pressure, causin, 
symptoms. 

October 23. — Patient resting fairly well. Complains of weakness. 

October 31. — Patient slept very little during the night. Coughed 
Tumor shows no marked increase in size. 

November 4. — Cough troubles patient very much, l)eing almost inc 

N(wember ..'/T, 7.V.V.V. — Tumor has increased in size and soreness. I: 
phia every night for some time: sometimes two tablets during th 
each. From this date until the date of his death the patient suffere 
with smothering and coughing, which was relieved only by the use 
Since October 9, 1899, he has had 75 c. c. of whisky daily. 

January S, JliOl. — Post-mortem examinati;)n, two hours after deat 
showed man of medium size; body greatly emaciated. Pear-shape< 
tmdes through what was the manubrium, to a height of 3 inches ab« 
of the sternum; this juts into the space between the clavicles and e: 
ward for 5 inches. The skin was removed from the thorax and tl 
through 3 inches from sternum. The sternum was then removed hj 
free from the aneurism: also the pericardium and pleura, both of 
intimately adherent. This brought into view a large tumor, beini 
portion or the aortic arch. This dilatation was almost entirely fille< 
of coagulated and organized fibrin. The first 2 inches of the aorta 
at this point the dilatation commenced and extended through th 
portion of the aorta to a level with the sixth dorsal vertebra. The 
emptied of the laminated clot formed by the organized fibrin -was i 
and 3i inches in diameter. The aneurism had eroded the entire ma 
the upper 1 inch of the gladiolus; also the sternal end of the right fi 
trachea was deflected to the right from its normal course and attact 
side of the aneurism. The pericardium was distended with 150 • 
yellow serum. The heart was pale and flabby. Right lung noni 
contained scattered masses of caseous tubercular deposits. The L 
completely adherent to the chest wall and filled with caseous and 
Trachea was filled with thin i)urulent material. The x)atient having 
symptoms than those recorded, and having died of starvation, there "< 
sity for making further examination. 



ANEURISM (SACCULAR), TRANS\T:RSE AORTA 

W. A.; age, 39 years: colored: nativitv. Missouri; admitted to the 
Hospital, St. Louis, Mo., Aui^nist JJ, IDOO; died October :27, 1900. 

Family history. — Mother died < >f pneumonia. Father and one brotl 
cause unknown. 

Personal hii^tory. — Had measles and whooping cough during childh 
and gonorrhea in early manhood, also syphilis. At present compl 
in chest and shoulder and of a bad cold. 

Physical examination. — Aniemic, fingers clubbed, and a sinlcmg in 
cle, superficial glands generally enlarged. On i)ercussion higher 
with greater resistan(^e on left side of chest. On auscultation , inspirai 
rough and wavy. Expiration prolonged and rough, especially on left 
nosis. tubercle of lung. Troiitmeiit. supjxn-tive and tonic. IXschargv 
19, 1897, improved. Readinitte«l to liosintal January 3. 1900. C 
pains all over chest, and dysjnKeii and i)alpitation of heart. Has soi 
some sweats at night. Bowels regular and appetite poor. Has 8 
Examination reveals a pnlsatin.LC tumor in second intercostal sx>ace,a1 
to left of sternum, givHng distinct bruit. Left radial pulse not as 1 
Systolic murmur at a(>rtic valve. I)iajj:nosis. aneurism of tram 
Treatment, iodide of potassium in increasinii: doses. Strychnine g" 
Codeine and pheua^/etin ]>. r. n. Discharged June 4, 1900, improved. 
August 22, 1900, coniplaiTiing of same 1rou]>]e as above. Gives hiaU 
a weight and feeling excruciating i)ain in lack just below lower I 
sca])ula, and of a sensation as of sonietliing giving way. Spits ni 
examination find dullness over entire? left sid(» of chest and respir. 
diminished r>n left side and increased on right. Com])lains consts 
and hypodermic injections of niorj»hia necessary at frequent inter 
ment supportive and to relievo pain. Death occurred on the momii] 
27, 1900, 



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124 MARIXK-HOSPITAL SERVICE. 

widoniiig ont almost horizcmtally t«> the nipple, then curvinK'<lo"wn qnin 
rally to tlie diaplimgui. Cardiar pulsation nnnsiially plain t«.) »»ye. I 
fxaniinatioii uf^gativo. He complained often that f<X)d jiassed x^art V^'ay t 
acli. then nmiained some minutes, and later slowly jiasseil on, or at times r 
tat^d. Pain (continued almost constant exce^it when relieved by frnlein. L 
of ])ain mainly in back, left thi^h, occasitmally in left testicle, nn>?ly 
shoulder. Rounded puls«atinj< tumor appi^ared in cpigastriniii and cont 
increased in size. TemiH'niture was H7 to ;{T.5 in the morning and 87.« • 
the evening. Puls«* varied from 85 to 1(H). DecM^mlxT i;}. ait H.40 ji. m.. 
ta8t<?d bl<jo«l and calltnl for nurse. A moment latiT he l)e|^n raising^ lilrHKl 
ful after mouthful until it amount^-'d to about a jrint. Pulse jcrew raj 
fet^ble. S<Hni he In^camc^ comatose and no more bl(K)d esc?ax>ed from 
AlKlomen lH.»came swollen and tymi)anitic. Death ensneil in t'wenty-fi ve ii 
AV'croyM// {tin ntf/si.v hours affrr dralh). — Bcnly emaciat€Hl. Alxlomei 
what dist+^nded. Ri^* )r m< )rtis present. Alxlomen ojwned first, contained 
serum. Stomach greatly distended with fluid. Other viscera apx^irently i 
Thonix o])ened. Clear serum, ti.soO c. c. in left pleural cavity and *26o 
right. Viscera remov^^d after tying all vessels. Left lun|? weigflied lOO gra 
right i)'2H grjims. Left lung compressed, crepitant only through upper 
ni)iwr lol)e: right lung cre])itant tliroughout, (inlema in lower lolx5. At 1 
tion of tnwrhea one calcitied lymph gland found. Peri(*ardiiini containetl 
clear serum. Ko adh<*sion in jdeune or iwricardium. Heart 'weijrhed Jii^** 
Valves comi)etent. Slight evidence of atheroma. Stomach measured JM 
8hf)rt4ir curvature and <i<> cm. on longer, and was 40 cm. in circunifereno 
its middle. It contain(?d 1.050 c. c. of riots and fluid blood. The liver ti 
2,040 grams and was of normal appearance externally and on Heotion. The 
weighed 21M> grams, was tiO cm. long. 10 cm. wide, and 2.5 cm. thick: < 
thickened, pulp Ann. dark red. Int(*stines negative; ])aucreas the same, 
removal of tlu? alK)V«i viscera <'xce]>t th(» heart, the diaphragm was cut a^ 
erally. The heart, aorta, and beginnings of tlH)racic branches were dissec 
and the a Mominal aorta from the iliacs ujm'ard. Tlie spinal ctduuin wa 
thrrmgh al)ove the eighth riband through the fourth lumbar vertebra and 1 
from the eighth down. j:nd tin? whole mass was then removeil. including t 
neys in- situ. A largi* fluctuating tumor had already Ix^en felt in front of t 
t(d)ra' both from al>ovc and from Ix-low the dia]diragm. After removal thi 
was alwrnt 20 cm. long fn)m above downward, !."> cm. wide, and 9 to 10 cm 
Th«; sac was filled with blood clot. Examination sluAved a division inti 
])8irt«. The original sa(r. l;{ cm. from above down by 5 cm. in dianiet-er. cv 
the anterior portion, and is indicated in the photograph by the adjoining < 
tlic two canulas marked f f f, the npiK'r **f " Ix'ing an artiii<-ial oi>ening u 
arch of aorta and the htwest "f " a similar opening at bifurcation i>f alid 
aorta. The canula "n"* ])asses (just al)ove this letter) int4> tlu» co^liac axis, 
was much dilated and was th(; lowest ]»oint of the aniMirismal enlarg 
(.^anuhi **k k" i)ass«'stliroughthesuiM.'rir)r mesenteric artery, which 'waonot 
ently enlargi'd. 15nrrowing from the original sac was another to the lefl 
ui»i«'r i»art, which measured 7 t*) >< <-ni. long and .") cm. in diameter. The i 
agus ran just posterior to this, and at the dt.H']>est irtirt of this sue "WBa a 
rupture into the osophagus. This e::])lained the iK-moptysis on night of 
the Hud<len distension of abdomen, and tin? blood found later in theatomach 
situation of this sac also exi)lained the difliculty in swallowing and the occ 
regurgitation of licjuid food. TIk^ cnnula *'g g" passes through the "whole 
of (i'So])hagns as tlisseeted out, while " h h" is a curved canula passing tl 
the rupture in s:»f and d«»wn the <esf»phagus to j)oint where cut jnst above 
ach. The i)oint of nipt iire wa>; too deep to be shown in photog^raph, Posti 
middle <f oriuinal s;ie w;is the tliiid. wliicli eontaiiied th<^ dissected ont and 
ernd«'d vert»'l>r;e. th«' lji>t tw«idi»r>nl and fir>r t wo b unbar, and which had fc 
the ribs on tin* left an<l oeeasioneil th«- feeling of fluctuation at upper part 
l»soas mnseh,' while sae and diai»hrairjM were intact. This vertebral 
cm. long from al)ove di.twn. lo cm. wid<'. and 7 cm. deej). 



S.] 



VAIATL.Mt DISKASK OF ITKART. 
Uri'fhf's lifsritsi . 



S. M. (colored): ag«». <J>^: nativity, Alabama: was admitted to United 
Marine Hospital March (J. Itioi: died June 11. \\U)\. 

///.s7(*/7/.--Four years ago lia<l an attack of fev«T. presumably mn-^m ^n 
having had any venereal diseas*-. Was treated in this hospital two yean I 



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126 



MARINE-HOSI'ITAL SERVICE. 



Jnar- ','. hyiimlermii-B of MnRPnilie's aolntinn of mnrpliia were giren to alla^ e 
ni«^nl- JiiiiHii, HdiiiiilimtHwuni Kivi-ii. Irat at iMi.) a. in., next day, hedieilqn 
.\n-r<ijiiii/ (iiiiii! Iiiiiii-n iiflir ile'ilh}, — IScidy that of a Wfll-iionrislied . iiid»i 
ailnltiiiBlK l.n.'iin. iiilenKtli: i^ailaveric rigidity well tnarketl: HUf;(^llatioDs in 
in nptuT cxtniuity, none in lower; (tnat (Krleina of lower eztn^mitie^. I 
WMKUt. 1 ,470 gmmn; (iura nut adlierent. KiiMnral npace contains 200 c. c. » 
flnl'l. Heart: In nlhi 1it-.art enlarKcil to l<-ftaiul (liiwnward. though sliKbtl 
vtitni] liydiaiihrHKtii. Weight. TriOKniiuH. Rifrht Hide of heart full of hlon]: 
tttiiiH li iHTii'i iKiHt-iniirteiii eint; jicwt-ni'irteiii cIotn in all tlie great v«!»,iiel«. ' 
nary Hinnn i-oiiKCHtwl. Tlio ii')rt)i contains aTi aute-mortem clot. The rif;ht ai 
caituiiiH M \uTKi! aiit^-niortt'iii cliit. Tliu aorti<; ^'alvo ia incoiupeteiit liyb 
Mtatii: teHt; B«fiueiitM Hlirnnki^ii, anil Hl■le^otil^ with iitlieromatons platen at 
rriot <if (lortu: wall nf aorta hyiH^rtroiihii-d. Tlie wall of the left ventricle s 
hyiH-nniiiliiu 'tiliitiition. The iiiitinl valvu is xhmiilcen and Uiinncd: tbt 
aiirii-le in dilat<-ii and liypfrtrojihieii. Tbe imlmonary valves are thinned 
ri({litventricleKliownhyiJHrtn)iihi(;rtiIatati(iii. The tricnBpid valve la tranBpi 
till) erlifi.'K iH-iiiK worn tliiii: tlie ri^lit auricle in dilat^-d. Lvmga: Weight, lefl 
(CraiiiH. riftlit h-.Mp gruinN; Hoat on water; marked eongeation and oedema, 
(■ially in lower lolx'w. KiKlit liiug iidheii'Ut at Iwiw and to pericardinm. t 
WiiiKlit. ■J.<HK)jn'aiiiH; noiliilalwl: I'onui'ctive tissue in eii^ess; nutmeg appeal 
on w^cti'in. Spleen: WeiKlit. ISfl !,'riiiiw: i-irrhiitic: indulated; capsale ailbe 
Kitlneyx; Weinlit, riKlit y:i7 (iruiiis. left ^'.''1 liT-.ima. Lobnlated; caiMnle lu 
eiit; intemtitial titwue in eicoHit. F;itty dexeiieratiuu of pyamids. 

J. X. 1 
C. W. 
J.M.' 



> Unitc<l Stutert M 



n. J.: ajiB. Till years: nativity. ArkHiimw: lulinit 
HoHpibil NovtaulKiT^t. IWIil: died Noveiuliei- S4. IHI. 

//m(ij ,■//.— Patient denies h;«iwK hail Nyjihilin or rheumatism; was first t 
niik HlHint twowe<'ks prior to admission. On ailmisNlon dyspiK^n was uui 
Hli^.'pint(waHdifflt:ultesi-iriit in Mttinit txisitiim: <MUL;h Hlight; snk)<>a and feet 
inatoiiK. Onnhysiculexniiiiiiation the heart was found to lieenlargetl frith sy! 
iiinnnnTB atutibki at lH)th Inuie anil aiK'x; aiH'x disi)ln('e<l to left and down* 
area of liver dnllni'siii'iinaidi'Tiddy enlarttnl: spleen not enlarged. 

AWnijis!/ {tiri'iil// lioiirxa/trr iliiilli).—lioi\y \rclliiimriahed: anblea and si-n 
ludeuuitons: rijcr mortiH powi-nt. Bruin: Weight, 1.370 grama: oW i 
uieninKitiH over vertex nhmfc hiUKitildiual fissure, the raenihranes bein^ fi 

inlhiTent t rtex and the summiidinK veins i-nm*({ed. Heart fatty, eepft 

on riitht Hide: Weight, (Svll grams: ehiikeu-fat elotfl in all la^-ities; left veni 
cavity slightly enlargeil and widls inni'h ilii(;kene<l: juirtii.' valves thickened 
rongheiiuil and oiM'ning enlarged: mitral leaflets apparently normal, but ope 
oidargi'd admits thni> tinK<'rs; aorta for fli'st indi or two tliickened and cal 
on». Lnngs Imtli show hyixistntii; eongustimi and pleuritic adhesions; right 
hopatiziilattiasi': '\Veii;ht. left lung. (iiUl grants: ru;litl.l.~><> grama. Liver enh 
andciingcptj'il; Weiglit.'2.1Ti> grams: gall bladder nimleratelvftill, Spleennor 
Weight, at") grams. Kidne>-snonnnl; Weight, left, 330 grams; li^t,290fr 

G.U. 



A. P.: age. .V.>: eolon-. 
Hoapital. St. Louis, Mo, 

Itist.-ni. -The patien 
iharginl iinpriiveil April IT, I 



to Auitr 



Ml. frum Fehn 



H. 



II April 1 
death, "n all these iMvasions he siiffere.l from .-^vn 
ermditinn "f the mitral valve. He stilted that he hii.l 
IHT4 whith la.-t.ll ten days, and that lie had hi.d slight ■ i 
He had never had a venereal wire, Imt had had gimonlit-it m 
relatives were dead and he did nut know what disea»ie 
hi» jian'nts. Tlie ^vmptoni.^ wliieh trnnlil'il hiui mfn» 
1>egan almnt Hftii-n liays b'fure lie lir^t came to the hosintr- 
congh and ocenKJonally jiains in liis ehest and al>domenj_ ' 
every winter for eis or seven years. 




M MUM ll>i-n I \l. -} Kvn I.. 



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121 MAKISE-H'^TTpITAL sEBVlCE. 

VALVrLAk HEART DISEASE. 

it-r.ii:.-. ; *.'■'■• >-. :!.' :■.-: w.-::fi,-. ;<>■ i^-nn-l-. 

A'l" >'7 h-jh.li.- M'-" Uifciiitf'-r- ' f fHtuily !■ inir-lived. Father snfferei c 
f."Wi rJ.'-tiii^'.>F(i. '«,«- lir"'l.*-r '!iM i.f uiiliary tnltrrcnlwiji. 

/-,.>.'.,«.! ti-i i.'t'.- II;.l tvi.i.'.i-l f'-vr v.-i.i> sKn. &!:<•> an artHck ..f g.H'^, 
II&<; -,>*■'] al'',li'.l -■t.-i'l r-,--ii. I-'.. Patit-iit jia.- liw-n in thw hoJidTsI tt-n nuir- ■■ 
(if '.f..-'-'^ f'.r rill tiif.ii*. -111. ii7:'l tl.f In-it .-f-rv-n f"r li^n duvrase an-l rheamiS 
Id .'.'■. V >-iii I ""-r. I '!'!". hi- i-i\:i-- h-r-- with -j'i''pl'''iii» <d bearT dist-sse of thre* tt- 
'Uirn'-.'iu. ''.n-i-i.iiiir '.f -linrrn'— |^t l-r-.'ith. (^«'iiia nf estremitiefi. con^h. u-J^ 
ttirlKwJ ■•".wia'li. UnriTiK Iii- ftiiy )i- hu'i ■n-casioiial slight rhemnarit- atmb 
■."iH'.N'! j'.iiith. TL- '-ar'Iiii': ^i(ftl- w re tliTii ilwfrilieil a^ enlar^uvnt. nnda; 
tyt.t'jlk iiiiinunr ii> tlif iijii-x. luml anil Kitalvz*'il. There were at first H{H 
(•'ilm'iiiarv (■'.iiK'-Mi>ii> a!,'l alliiiiiiiiiiiriH. tlii?>e lati-r fUlKiilinK- Tben' wne. 
"i;fii-'.f |.I<-iiris-y. AfiTiii-tay «f Tw.i mmiths liu was alile to go crnt. TV" 
.1— iv \if!t>i ps>-iiili]'- till- tir?.l. iliff'-riiiK inily in the severity of thp xvmiiti': 
rpul.-r r<-i ftij'l n\<\<iu\iT\:it>- iniiUr'uiii'ii i-'iniin-ii^Htiim liwame" rewitahliiiw.'^ 
t<. fiiil iixiiiii 'iJj tli'i r'-aiiiiiti.)ii .if iiftivi- lif..'. At n physical (^xsiuinatitoi it. 
'»-1i.li.T. V-fi'i. till- liiJirt w;.-, fiiii7i'l i-n<iniioti«ly t'i]largt.i1. its actiim fitnffl 
irri'Sfiilar; ili<'r<- wiisiil'-ivl niirra) iiiuriiiiiriiiviipj-iiiKthesecoii(l»KiuailaiidiL'" 
ivir\'v iiiiiniiiirdf i)i'l<-l<-niiiiiHl>li- rniuiii'WewiTlirvEerenw to the sounds, ^i 
'.f iiii iiM jili'tirihy wtiHr funtiil im tli.- T\ich\ siil^ of the chest, and even somrif 
(■IT'iKii-ri »-:i4 .Ktih)i(ii:ti''l. :i1t)i'>ii-<h im ftni'l wan detained iii>uii aspiratioD. 1 
iiriii': »ii". l>tit hliclitly iillmiiiinirtisHiid iiiM-astMwtTc present. There was eitH 
■Irji- V. i-iuith. <lyn)>iiii':i, iiiid Kii^'i^'' 'listnrlutni^i. 

lV'" I'v'vitik h>-r.'. Ill hiHn-iLiii-Ht. on Jimiiar\- 7. lOOl. be wan warned be to 
iUuvt of hi-« u1l..iiiiiliii« l.iir.1 work i.-iiin. 

When lir»iit{ht l'it)ii' )i<ih|jitiil in llii' iiiiihulimco the last time. .Tannarvl^. 
■iiii'lit.i'>n wiiH v.'ry Imi): he wiw iimiiivt'iitly in •■xtiruiiK. There \raa grwitif 
of \\u: \iv, ort.lin)tiiii-ii. rnonnoiiK cliiiti'ntiDn of tlii.' cervical vessels and c,mK< 
itI'l-Hly itini-nN wiih cDUKhi-)! n]i at iiiterviiltt. Tlie heart was apparently m 
■■rihirifi'il'ind iimirtion wiiMViTy frn-Knlrir, T<i-and-frainnnuar8i7ereever3ntii 
;uiiJil>t>-. aiirl ]>nlHiiti<>n!< ill. t.hi! wrist, did not cnrreHixiiid to the heart beata'<el 
n^wof thi' liill.T riii-hiiiiiil. I'lid.-v thf' inlinence of rent he improved t&^ 
for II fi'W iliiys. tlii'n Kiiik iiitu n HtiiiHircinH cuiididon. cyanosis iiicn^ard.il 
liNuirl wiiHrrii'iKh'-i| ii|' lint imr c.xiK'llcd friini the liiimth. <»theterization bni 
riiTrF.Knry.iiii'1 IiimM-'iI willioiit n'iriiiTiiii(f ciinw-ioHsnenH. His mnscular audi 
|Hmi' tihHMt<!i ilii] tint HiilTiT iinnh. Th.-n- wiis no fever during his last atoy. 

M'oli'-iition Wiis n.vii[]>l"i[iiitii' iiini tli>' eiii]iloyi[ieiit of such remedies us digiti 
Mln>|>hiinUinH, H|iiii't<'iii. iiilniKivii'i'ln. s^ihcvlic tu-id. iKitausiam. iodide elatoii 
rti-,. when iniliiiiti-<l. 

Si-ri'timii ilhiila hnitiH xflfi- ''.(i/Zo— Bo-ly thiit of 11 male, apparently aboB 
yi-um of itKi-. l{i[{i.riinii [Hwi-iimrti-m lividity'ii resent; l)ody well aonriabcdi 
iiiiiw'iilur: piitiilH I'viiily imd irii«lcriiti'ly dilati-'t: lejw Bomewhat edematou 
in<-ifltiin<rontii<li'riL)ili'siLU'uiiiiii-<<iisfiit fnuiid: skiOetiii muscles well derdopcdi 
of iiiliirlii-iilor. MiNliii^iiiiiini. (irciit inir'-iv<eof arraiwcnpied by the bitfti 
jiliTKirniJil HeiKinilioii of the iiiitrTi.ir edjtrH of tliu Innftii. Thymus ram^M' 
found. |N-rii'iirdiiiiii •niit.iiiis :im nhnnniiiil iiinouut of clear yeUow b 
Hiii-liiiT is Kiiinodi iiii.i wliili'. lliviit is viTy lavste. (>iicn©d in altuKni 

trii'l.'sf..iin.l tnU. ihliii.ii, \W liiilil v.-rviiiiirln-iilv. Theri*h*' 

ll<ii.liiiid,'l..ii.>.|l.1 l,ih..l.-t( is,,rii.1i.-.-iIlv.-niiit-v. r " • 

Ih.' uorlii- and 111" i>iiIiMi>iiai'y vi.Iv.-sari' I'oiind iiisiiflit 
'riii'rij,'lii aiiii<*iil.i n'litririiliirorillci' admits llin-i'liiit-'isciisil; 
tiliri-lv iKliiiilsoiii' lini;''i'. is i<f I'n-wi'iilif sliniNMiiiil is tiai*ro 
1111.1 a'.lh.".iMn Ml- Ml.- vah.'l.Mtl.-t«. Tholnirt.'lsof t1n- a..itii 

!■ 1. ni.«.' ..1 Ihr imliiLiiiaiv aii.l (rirusind ml- 

th.- niiind vjilv.' .-nonnouslv Mii.-kni.il ami tl 
<|.-|HisirN. Mv.H-iir[|ttim. •■-^iH'.'i.illv <•! t)i- i-tL.'ht ' 
M."«. H.-art'w.'ii.'li-'.ixis.-r^ini-., I,.';! i^.-nrai (■avuy is ir. 
or a.llii-si..ns. Kiiiht (.l.-nral lavity isalmost omirely ol.ll" 
Till' limi:Hri-«.'ni)i1r»a.hoMi.T ill N-iiii.'iili'iiia1oiis!uid«p| 
aii.l '■\ik1iiii: frothv Idixxl and si<nim froiii the ci 
Ihik.' imnmnt of fai. syli-^n w.-inhs -Jin |;^lm^. . . 
killni'Vivi'iuliH'.'liif-nnns.islinn.i'nIsLilittli'hiiril.imd' 
■iiii'fai-i' wilh fairly ilisTinrt markiiip>.lii:lit-i-oIi>n ' ' 
mtiis. itiid the i-oriex ot uowrly uunuiil tliik-kucsii. 




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V«l«1rt . 11 -IslAlrvl TIh* |ittilU'ilMinr «aU ••«•:• I. ri »! • i ' > 

r friv r^ltfM* bv4lV IWMVlly III J %■!(• C^?. - 

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MARrSE-HOSPITAl 



- ^'canTy. The or^n i' Si'.r 
■ut Hnrfw-H iiiilf aii'l ()i--iiiarkiiiit'' iii<ti.-tini-t. Thecort«^xis IiiiL'k>iifd. ; 



Hiiii iihIi-. N"«r tlip 'iiit(:r )»,Ti\rr i- n suuiU >liii]lf-w 'Wivsrion ■vrith a wliii-' 
Th" flit Hnrfw-H iiiilf aii'l ()i--iiiarkiiiit'' iii<ti.-tini-t. Thecort«^a" '--'-=' - • 
fiiie lit the jiyniini'lH. wmt th-.- ai>t-.t. ii^ n whit'- f-whoricnl limlv. 1 



kiithr kiibifty: W'ij^lit. I.Vifrniui-.; pRtcti'.-Hllr the :<nue a^ tie li-ft. GuUliWl' 
in iii(i(l(:rat(-l.v ■lifit<-ti'I'-r1 wit)i ilarK-lir''\vii (lui'l. LiTC-r: Wvitfht. '2.f<"i} ftnc: 
xliiftiily imhtTitmU mirfw'- KitiiKith: iraji-ul*- i/t iiunnal tenidon- The snrfaiti 
|rit1n Willi lili>i>tl--'lajii':(lar<-nx: c'lii-istMiryiiurmal. While»pot.2ciii. iniiiaiij'ir 
]■. mv-n oil til'! njijrfir !iurfii<-i- ut 111'- risht I'Hit: Tlie liver is pale on sei'tiin t 
Mi'iws '■vi'i'iji'- of fatty fluinKf. BlxHt i^xniVs fivm tli'.- cut narfai'.', Intrri?- 
an- iji'iili-ruti-Iy iliHt'ti<l<:il with (pi". "thi-pwis'- ii«nu«I. Bladder in shgliTiTJi- 
t''ii<l'^l with nriii'^. Tiiira iiiiit.iir Nhows fri'lrmc; 'if ni-ent inflauiiiiati<iii aiiinsri- 
litHKitiuliiial miw. Tlii-n- is :t ciiiiill Miin.uiit "f filirin an the pia luaterof ti 
Hiiji^'ir BiirftMy 'jf til'- '■(•riljmiii. Untiii: Weight. 1.430 grraiiiA. Is lytr*: 
HTi'l ti-HTM eJurfly, iiTiilNilily fnnii ii')!it-iii'irt(fln cbango. On section it siwi 
Hliii'iniuility. 

R. L. IT 
J. H. ft 

A.,rlir,i,„l w!lnil. 

(). W. F'.; IW: l>; iiativilv. .-»''>llmi<l: ii'luiittnl to the Unitetl Stat^ ^aR- 
|{<iM{iitii1. IJfml.m. Miifw.. Miir.li 'Jl. jiiiil 'li'-<l .Inly III. IIKHI. 

On Kxniiiiiiiiiioii, tlii.- fnllowiiiK jjiiiiits "f iiiti^r(!.-it were revcalud: Patient sat'' 
from ilyii|iii(i'H. whi'ili iMiiicrfiasuiliiuiwrlii']!. iiain over oanliac region. iiiiuaU 
(liKXiiifM*. hi-iiilaiOiK. mill jHilpitiitiun of tin- hi«rl. \ pliyiiical exaiinuatitiQ ^tK** 
on iiiKiHittioii, H iliitiiiiiHliiil iiisiiiniTioii willi a proloiiKed espiratioit, aVv a ili^ 
i-arolif! tmlHiilioii, (in ]in1iHtii'>ii tin- aju-x Ix^ut is Kfr»wner than uoruial siiiH^ 
Iiliui'il ilowiiwanl utid 1" Ihc li'ft. <'»i) alHi> fi-el a iliRtinct anriunlar tbnil><^ 
til" lliirti anil fonrlli leftinh-n-o^ttul mbiitm. I*aiiiiit hiuiadJHtiDct OirrijMn pis' 
(III iH'ri-iiHxi'in t)ieii> U ail iiii-r<-iii<<^<l ar<-a of I'anliar ilalluoss, both n-lutiicn' 
iilwoluti'. (Ill iiiiwiil till inn tlii;n' U a limd, I'liajrh. ami blowiiiK' (liastoli' iK? 
tiiiir li'iini 'mr thi' a-'itir una :iinl tranmiiitteil alonK the left liorder of » 
Ktcriiiiiii. Tlii-n- iHii tilsu In- lifiinl a wift hlowiiiK Bystolif- ninrntfir over* 
Kiitral anil. tnniMiiiilti'il townnl tlif iixilli try line. Putii'iit wan pnt to Wk^ 
t(Wfu liiiirt tunii-H. 

Oii.hiiir l.'t tliriiutii'iH inniiii u.-Lii.i^tonitiiiKlil'Hxl'luilinvwnted a i-ervamJ'O 

tiKinti-iiiii : tliiT.'wn« Willi" 'i-iliiiiii '.f tlif f'lt Hiiil K'K». On July ffipaic 

ilfiil rniia liiiirt fiiihiri. 

../Mil/ Uhirh'i' li—'iM ',//./■'/."//' i. -I 111 iii-^iK'i'tion tlio fu^t and Itfi^^ 
lUniial'ius. [iiijiilM 'iimillv liiliitfl. ^i^'"r iiiortiM iireseiit only in the lii" 
'-= .. |iiwt-iiifivt<'tn liviclilvtiiarknl. iiiimih filUil with dark frothy U>' 
Koreans: H.arl tlirn> tiiiif.^* in iiorniiil MKe. tho u-alla Hli^httjbiT* 
lIkIiow^ sum., falfy il.-«'-m!rntioii. Tin- Vi>iitrii-h-s anil anri(ilf»«' 
.iilal'il. W.'iHlit c.r liciin wiW -VKi uruiiis. The valves, both ■i« 
. wrrr in'-omiwlitif. Tin- arl.'i-ir- with iiomiiil. Reairiratoryoi^ 
liiryiix. iimi trai-lii'ii w>'ri' iionmil. The hft lung wan cmngMtH* 
;il KMiMs. Tliri-iiiht liKiK wjw n.nKestril atnl W-.f^liM 1 im^ gi* 
1 I'livilyiniil ]>li'iint were iKmiail. (4ii[itni-intpatiiiiil traet- Tlict-Ji^ 
i-soiihii^jiiM, utoiHiiih. mill iiit<'stiiii<.t iii.niml. Liver was notipi** 
. ati.l wiwhiHl I. IINI uniiii-. Till- Kiill hla.l.l.T was filled with haTB" 
:lii'i r-> ;;raiiiN. Th- innK-n-iis wiij-li.-d Hhi jirams. The ki»tom^ 
L|.tH>iiV!iiir.'. ilu'l.Ti wi;.'hiil l«ilKrii!!i«, the right we)|;hed 300 '|f " 



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"■I.','- *<-v.:r a;.'! .>* ; ;.; :--.-■ - :-:---- :.:■;: -^Iifc*!. pMieat »«• itf 

/•■r.'-ra; '-.r.'!;r.'>*.. ■! - ■ v-^'i -.: I ■. :! :..,,r.:"i -iT-^mwA sad puniiiii 

r(i'<-' ir.ar^r-i'l 'v.-r l-f- 4:.--r: r ;■..-: :. T-.:_:-roT=r«-. a*.*; polee. lOa. Hf 
ia: <-^«iii.r.;i*' .:, -:.v.--l -1,- i^ -i:.:,-- . f T..e ■.■!:**t to be - - _. . >!-i 

Uh"!, fliilji 'i-.-T ^'t.': '.:■ l.---. : --.•■-■?. ..--.jl-i wiifc dfai 

■•'.rtii'I-. *■;*.-'.:«': 'J-i::r,'-- -.v^- :r. r"..-- :. ;:.r::--.:ar:ri« a Uieral dincfiKi 
tl,.- uyx •m- i.- „r-i a -■-• r.: ■ — .-r.-.T. " : Trix-x in ohanacter. and 
t . t:... -.ixVAn. At fi.- .-:.-:• r:;. v.r"::.i.-- -^;i- h-ar.1 a aofter ayMci 
"-..■r It,': h'.r:-: ■.I'.vi- -.va- !.---nr: .1 ■:;---■■'.:■.• cmniHir. Vieal^ p. 

|,liiji,!y'-.i.i-Pii In 'h': j^r;:;.-rJil ■■—:■.-. Pii^patioD ^hitwed ^ r^srj , 

I ->.rn:-ii: j.iil- . 'n. 1.;^ ■:;ri.*: t. f ri,'- f:ir-.tM*. .(abtOBviana, and lm» 
'I'.iil.l' iinintiiir- W'Tr- r..-ar'l. X'.'v.-i-;;-Ta:.>t:ii/ trwitmpot tlw patient' 
f'lifri.w ^U'iitY.lv wiT-r. I.!.'- ilv-7.!i''-i j.i TV ;-r'-;ii<niiLt»l.tW pain itMttns 
111.' w.:.ki..::-. iii..r<- iii^rt:.'!. I;';«:i. ■ :.:..■■ f--A<l'nlyDX«.^p. m. Ueoaa^- 
::..;..,...., I i,„,rt-^„ h:»< "I'-.- ,:. ■■■ .—T'.^.m"neiA BviditT alight BP 
iii'Tii^riiiirtxI. <i".iii-THlii',nTi-}.i!ir]ir i-.-l, (.fn-nlatory organs: H<ait.«# 
«l't rr.iiii-': IiTl. v'-ritri'l'; inark.'Ky .ii'-nr.-.l: wall* 1 tn 3 cm . in tbiddMEKill 
v<'rilri>'|ii:i)Hi>'(:liir;;<"laii<l'lJliit'-I: wii]l-^.iiii.-vrli-Jt tliintierthaji l«ft. Bi^" 
tri'l'f i'iiriliilii>;<| a i—'t-iwi^-ui <l"t: li-jili anrii-lirs were dilated, tlie ri^' 
twi''- iu (I'lrtiiiil (■:iiNii-iiy: nil th-- viilvi-s ..f Ihm hiiirt were incompeKml: 1 
l.'ilivii pn--.---.- jif'H'-itti-'l at tl;'; ii.irt;r: viilvi.: iliij A'lrtA aud other v^wl»" 
h-irrn:il. l(.-.|.iriil'.r,v 'ir;.'HiL-=: Itiiilit Itihl'. v.-..i;;Iit, 1.171) gianw; cougMted U 
iiiii;'. wi-i^ht, MKi Kr'ii"": K'>ij»'u-]iiit ' i<ti:;i'.t<-'l. litit not m Euncb so as ligbt; Hi 
iijM s '.r lliis liipiji. iLiir til" jitri'-rinr li.,nl.-i-. wi-n,' f'nir or five>-ery BKaUlnlieA 
Kiitlit. i-liTmil '■Hvity <-ni,1;iii..-il fl-.u .-. ,: nf wrnns fluid. The left dImibO'*" 
'■i,rii;,ii...l r,(i(i .-. <:. „f ilniil i,i..l i.i-..>..iiti-.l a f.w (.light adhwionrin tl* ** 
juiUiirv lii"-. 'I'lii' Ka':trij-iiii.>iiiLiil Iriift iv.is iioniial with the exc^ptiincll 
hI.uiijkIi. wliiili wjitililuli'l. I>iv(-r: \Vi-i;.'lit. ■-'."fidi.'raina: conKmted. K* 
Itiiilil.wi'iuJit.'.'ir.Hrain-: i».nj.iil. LiTl. wi.iilit,','ij(i(.'rams: cortex tfaiokrwll 
i;i|..u|i- ii<lliiTr.ii(. lii'iiiii; \Vi-i;.'lit. l.-''i'l ^riims: dura mater s]ie:htly attM 



fitnil ,-v"ruil<ili>»,. 

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126 MARINE-HOSPITAL SERVICE. 

Jnne 'J. hyiM)dprmic8 of Ma^pnclie's solution of morphia were ^ven to allay exr 
iiieiit. June :{, stimulants wartr given, but at 2.;^() a. m., next daj'. he die*! qui*: 
ycrrajisf/ {uim; InmrH (tffcr <fnifh). — Body that of a woll-nonrislif*d. mus-i; 
adult male 1 .05 m. in len^h : cadaveric rij<i<lit y well markeil : HU|r^llations icv* 
in upper extremity, none in lower: groat ledema of lower extremities. Bn 
Weight, 1,471) grams: dura not adherent, subdural 8i)ace contains 21K) c. c. ^fr 
fluid. Heart: ///«//// heart enlarged to left antl do\vnwarcl, though slightly t 
vated by diaphragm. Weight. 751) grams. Right side of heart fnll of blo«>d: ci 
tains a large imst-morteiii clot: post-mortem clots in all the Kreat ves-sels. Oi 
nary sinus (M)ngested. The aortal contains an ant»*-morteni clot. The right anr 
contains Ji large aiito-mortem clot. The aortic valve is incompetent bvhviii 
stiitic test: segments shrunken, and sclerotic, with atheromatous plates aru 
root of aoita: wall of aorta hypertrophied. The wjill of the li?ft vtrntriolp.«b' 
hyi)ertrophic dilatation. The mitral valve is shrunken and thinned: tlie i 
aurich? is dilat+*<l Jind hyi)ertrophied. The i>ulmonary valves are thinneil:! 
right v»»ntricle shows hyiM.'rtro])hic dilatation. The tricuspid valvo is transfaiH 
the edges lK>ing worn thin: the right auricle is dilatetl. Lun^: Weight, left 3 
grams, right N2() grams: float on water: mark(?d congestion and (inleiua, t^; 
rially in lower IoIk's. Right lung adherent at hiu^i' and to peric-ardinm. Li^' 
Weight, :l*,0()0 grams: nodulated: <-«mne(rtive tissue in excess; nutmeg appearai 
on section. Spleen: Weight 150 grams: cirrhotic: indulated; caiisule ailht-M 
Kidneys: Weight, right 0;J7 grams, left "i'2{) grams. Lobulatecl; cai>snle :idh> 
eut; interstitial tissue in excess. Fatty degtmeration of pyamids. 

J. N. F. 
C. W. V 
J. M. 0. 
Atu'ftr mui in it ml, 

H. J.: age. 5i) years: nativity, Arkansas: adniitte<l t-o ITnit«^d St»ites M^ri 
Hosi)itiil NovemlHir 2:J. liHM): died N<A'eml)er 24. 1000. 

Ilistih-}/. — Patient denies having had syjihilis or rheumatism; \ras first tak 
sick alH)ut two weeks i)rior to jidmission. On admission dyspn(.t»a "was mart* 
.keeping was difficult except in sitting ])osition: cough slight; anklf h and feetti^ 
matous. On physical exaniinati< »n t he heart was tVmnd to l>e enlarge<l with sr*" 
murmurs audible at both base and apex: ai^x di.sphu^'d to left and downvi: 
area of liver dullness considerably eidarged: spleen not eidarged. 

Nrrrnpst/ (fwniti/ hourn aftvr dnith ) . — I5ody well in>urished; anJcles and si-piti 
(jLHlemat^)us: rigor mortis ]>resent. Brain: Weight, 1.JJ70 ^ams: old fcl"! 
meningitis over v<*rtex along lon.idtudinal fissure, the membranes being fini 
adherent to cortc'X and the; surrounding veins engorg<'d. Heart fatty, especii] 
on right side: Weight, 020 grams: chicken-fat clots in all cavities; left wntn 
cavity slightly enlarged and walls nmch thickened: aortic valves thickened ai 
rouKhene<l and opening enlarged; mitral leaflt^ts apparently normal, but openi 
enlarged admits three fingers; aorta for first inch or two thickened and calc« 
ous. Lungs both show hypostatic congestion and pleuritic adhesions; right In 
heimtized at lKi.se: W<'iu'ht. leftlung. 000 grams: right 1.1 50 grams. Liiverento 
and congested : Weight. 2. 1 70 grams; gall bhiddor moderately fnll. Spleen norm 
Weight, yOO grams. Kidneys normal: Weight, left, 220 grams; rijicht, 220 gnu 

G.u.r 

MUruL 

A. P.: age, 5I»: colonel: nativitv. Kentucky: admitted to United States Mali 
JIos])ital. SI. LoniH. Mo., May I:{,*11M)1: died June 5. \\m. 

JIisf(nf/.--Thv patient first caine to the hospital April 12. IftOO. and WM <1 
charged im])roved April 17. 1!mhi. ]!<. was also in this liosjntal from July 28 W 
to August 2i>, 11)00. from Febniarv 5. llMH.to February 2:{. 11N)1. frou/^j^i 
11)01. to April 12, 11)01. and froin May i:J. 11)01. to June 5, 11)01. the dateof' 
death. On all thes(» or<asions he sutferiMl from symi)toms due to the disrai 
condition nf th<» mitral valve. He stat<d that he had ni\ attack of rheuuiati^^H 
1S7I which lasted ten days, and th.at he had had slight rheumatic pains ever an 
He had never had a venereal sore, but had had gonorrhea several titnes. AH 
relativ4fs were dead and he did not know what disease had cause^l the death 
his parents. The symptoms which trouble<l him iriost was dyspncea. wt 
iH'gan alH)ut fifteen days bi'fore hf first came to the hosintal. He also hadaslil 
cough and (K'casionally ])ains in his client and abdomen. He had had the ox 



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128 MARINE-HOSPITAL SEBVICE. 

VALVULAR HEART DISEASE. 

J. S.: aj?p, 54: uativity. Siotlaml: «'nlmittwl t«» United States Marine H'.*jfli 
at Staplf*ton. jK^rt of X»'W York. N. Y.. Jannary ix. 19<)1 : flied Jan nan' ',*'i. 1>. 

Hei^lit. ■") f«.H^;t it iiirhf-s: weij^ht. I»i<)ix3un«l>. 

FamiJifhistorif. — Mo.st meinVifrrs rif family loncr-llved. Father snffere-l mrJ 
fn>iii rhf'Uinatisin. One l>rnth»^r dit-d r.f miliarv tuberculosis. 

J*r('riiniH sirk'nrss. — IIa<l tyi)li<ii<l f«;\>T years a^o. als<i an attack «.>f gemontA 
Has iitM'd alcohol and to^arco. Patient has l>een in this hospital ten tiiufr:^^ 
first three for rheuiuatisin. and the last .seven for heart disease and rheumarit 
In November, W.)x, he eann.' lier*; with symptoms of heart disease of three wtrc 
duration, consisting f»f shortness of l»reath, e<lema of extremities, congh. tal i- 
turV>e<l st4)mach. During his .stay h*- harl <H-casional slight rheumatic attack*: 
various joints. The cardific signs were then descrilied as enlargnieut. andip 
systolic murmur at the ajM'X. hmd and h)oalized. Tliere ■were at first BipL- 
pulmonary congestion and aHjuminuria. these later sul)sidin>^. There weivu 
signs of i)leurisy. After a stay of two months he was able to go ont. The s 
cessive visits resemlde the first, differing only in the severity of the symr*:!: 
Und(»r rest and appropriate medicati<)n comiH-nsation l)ecame* reestablishrtl. ^i 
to fail again on tlie resunii)tion of active life. At a physical exaiiiinatinnm*! 
(KitolMjr, UMM). the heart was found <'normously enlarged, its action extwfc 
irregular; there was a loud mitral murmur (x'cupnng the sei^ond sonnd audaka i 
aortic murmur of indeterminable <H'currence with reference to the sounds. Sr. 
of an old i>leurisy were foun«l on the right side of thtt chest, and even botkv^ 
effusion was susjKM'ted. although no fluid was obtifdned upon aspiration. Ti 
urin<j was but slightly albumin< nis and lu > casts were present. There "was eitis 
dropsy, crmgh. dyspiuea. and gastric disturl>ance. 

U])on leaving here, at his re<iuest. on January 7. 1901, he was "warned as to4 
di«ig4*r of his attempting hard work again. 

When brought tr> the hospital in the ambulance the last time, January 1^.i[ 
condition wjis very bad: he was a])X)arently in extremis. Tlier© "wks great e^ 
of the legs, orthopmea, enormous distention of the (cervical vessels and cyan* 
lJl(x»dy mu<*us was coughed up at int*frvals. The heart was apparently nar 
eidarged and it« action was very irregular. To-and-fro mnnunrs "were everywte 
audible, and ])ulsations at the wrist did not corresixmd to the heart heats, only 
few of the hitter remdiing it. Under tlu? influence of rest he improved digit 
f*)r a few <lays. then sfink into a stuporous condition, cyanosis increased, dji 
bliMKl was couglied ui» but not «'xpelled from the mouth, catheterization beets 
iiecessjiry, and he die<l without regaining consciousness. His mnscalar andai 
lH)se tissues <Hd not suffer much. There was no fever during his last stav. 

Medication was sym])tomati(* and the employment of such remedies as (ligitati 
strophanthus, si)arteiu. nitroglycerin, salicylii; acid, potassium iodide, elattfid 
etc., when indicated. 

.\irrnfisif [thirttf Jiniirs after drttih). — Body that of a male, api>aTently abofli 
years of ag*'. Rigor and jMJst-mortem lividity'present: body Avell Aonrisheda 
muw'ular; pui»ils evi»nly and mcnlerately dilated: legs somewhat (^dematons. ( 
incision consideral»le sulx-utaneous fat found: skeletal muscles "well developed > 
of a dark color. Mediastinum, (ireat increase of .area <x^cupied by the hcwtii 
abnormal si^imration of the anteri«»r edges of tin? lungs. Thymus remains i 
fi»und. Pericardium <*ontains an abiiormal amount of clear yellow semm: 
surface is snumth and white. Heart is very lar;;e. Openeil in ttitu and both^f 
triiles found to be dilat< d. the rijrht. very niarkedly. The right ventricle coDtt 
fluid and clotted blood. th<' left is]ira(ti(ally enipty. On removing the he^utbi 
the aortic an<l Wv ])ulinoiiary v.dvt's nre I'ouikI insuflicient to the hydrostatic tt 
The right auriculoventrieulMroriliee jidinii>< three fingers easily: the mitral orii 
barely admits oM(» timber, is of i-res«-entic sliap<>.aTnl is narrowe<l by thecontract 
and adhe**ion of tin* valve lentlets. ThehatliMsol" the aortic valve are innchthi 
tiled, those ol' t he pnliiionaiy and triiu^^pid valves to a less extent, and thofli 
the mitral vahe enoniionsly thickened an«l the .seat of nniuennis calcani 
deposits. My4nardinm. e>i>i'ei;illy ot thi* riu'ht ventricle, much reduced in thi 
ne>s. Heart weighs V.Hi grain«i. I.eM j»leural cavity is free*from abnoTmal ft 
i«r ad Illusions. Hiu'ht pleural civuy is almost entirely i^})literated byoldadbeSH 
Tlu'bmu'sroembheai liothi r in iM'iiiLcrdrniatonsand <'ongested, floating in vfll 
ainl cMidJnu' frothy blot^d and mtmiii tri>m thei'iit surface. Omentum oonMi 
lari;i' amount ni' f:it. Spleen wiml'Iis 'Jh* grani'-: is firm and dark colorad. 1 
kidney weighs III t^raiiis. is firm, cutsa lit tie hard, anil ]iresents on cut a^^Mtf^Hil 
surface with fairly distinct markings, liirht-colored stria^ l^^ing vislbla 
iiiids. and the c\>r{e.\ of nearly normal thickness. Right kidney 



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130 MARrNE-HOSPITATi SERVTCK. 

kidiuiv: Wni^lit, 14i) ;^iaiiirt. ivriuuphritic fat is scanty. The organ is flilif 
and i»alo. Noar the outer b«>r<ler is a small shallow depression with a "whitf Iwe 
The (!iit Hurfare is ]»al<^ and th(^ niarkinjrs indistinct. The cortex is thick»*n«i. t 
one of the jiyramids. near the apex, is a white si)herical Ixuly, 1 iutu. in diiinif:*: 
Ri^ht kidney: Weif^ht. Lm j^niuis: practically the t<ame as the left. Gall blfrii- 
is mcKlerateiy distended with <lark-l>rt)wn fluid. Liver: Weig^ht. 2.<>oO gnie 
sliKhtlv eidar^ed; surfa<<' sni(M)th: capsule of nonnal tension. The surfsfti 
pale with blood-stained areas: consistency normal. White spot, 2 cm. intlianMf: 
is Been on the upi)er surface of the ri«,Oit l«>be. The liver is x^ale on secti'.m. - 
bIiows (;vi<lenc;e of fatty chanp'. Bl<M>d exudes from the cut siirfa^.v. Int»i*nT.- 
an? mo<htrat<.dy distended with jijas. other wis(» normal. Bladder is slightiVCS' 
tended with urine. Dura mater shows eWdencr of recent in flanii nation aUmi: 'i- 
longitudinal sinus. There is a small amount of fibrin on the |)ia mater of tl- 
superior surface of the cerebrum. IJrain: Weight, 1.4*20 ^auis. Is verT*!i!" 
and tears easily, prol)ably from post-mortem clmnge. On section it shy^t 
abnormalitv. 

R. L. V 
J. M. li. 

Anrtir a ml in it nil. 

G. W. P.; aj<e, 41; nativity. Scotland; admitted to the Unite<l Statos 3far5 
Hospital, Bost<jn, Mass., Mar«li 'J I, and died July 10. 1U0<). 

C)n examination, the followiiij< i)oints of interest were revealed: Patient ^oJ-^ 
from dyspno-a, whi<.di is increased on t^xerti on. pain over cardiac rt*Ki'»n,inft«iEii 
dizziness. heada<;he. an<l palpitation of tlu; heart. A physical examination sb)**- 
on insiH'ction, a diminished insjaration with a i)rolonged expiration, also a tlisffl' 
carotid pulsation. On jialpation the a]M*x lK>at is stronger than normal andfr 
placfsl downward and to the h-ft. ( 'an also ft^^l a distinct auricular thrill «■« 
tlu* third and fourth loft intercostal si)ac(s. Patii-iit has a distinct Corrigan poJ^; 
On i)ercussion then' is an increased an^a oL* cardiac dullness, both relative » 
absolute. On auscult^ition then' is a loud, rough, and bloxn'inp: diastolic is* 
mur heard over th«» aortic ana and transniilted along the left border of l* 
sternum. There can also Ih; lieard a suft blowing systolic niurmor o\"er*j 
mitral area, transmittt'd toward the axillary line. Patient was put to W * 
given ht*art tonics. 

On June 1") the patient lu'gjm exjH'ctorating blood and presented a veryant^ 
countenance: there was soni*- (cdenia of the feet and legs. On July 10 piti* 
di(?d from hwirt failure. 

Xrrronst/ {tin via n hnui's c,fti r <hiitli).— i)\\ inspection the feet and legs** 
v<'ry (edematous, pujnls equally dilat«'d. rigrn- mortis prest»nt only in the fcj* 
extremities, ])ost-moi-tem lividity marked, niouih filkMl with dark frothy blft'* 
Circulatory organs: Heart threi* times its nr)rmal .size, the walls Mlightlvh.n'^ 
trophie<l and shows .some fatty degeneration. The ventricles and anriclwW 
very much dilat<Ml. Weight of heart was r>0() grams. Tlie valves, both *<■ 
and mitral, wer4* incompetent. Tlie arteries were normal. Resinratorv (Of^ 
Tbe nose, larynx, and trachea were n«»niial. The left lung was congested i^ 
weighed TiTO grams. The riiiht lung was congested and weigrhe<l l.tOO gnV 
The pleur.il cavity and jdeura wer«^ normal. (Castro-intestinal tract: The tool* 
jdiarynx. o'sopha;;us. stomach, ami intestines normal. Liver was iintmeM 
apiM-arance and weiglied 1. loo grams. Tin? gall bladder was filled with bUeTl^ 
s]»b'eTi weighed I ."»0 ^^rauis. The ])ancreas weiulied KM) grams. The kiilnevBW* 
iioiiiial in ai)pearance. tin- l»tt weighed ISO «;ranis, the right weighed 200 gn* 
The brain was norniiil and wiiirlie(l l.'J.'iO grams. 

F.L 

Mit I'lil nnil (un'tir. 




])alpit^ition of tlie heart, jind li;id nn s«*v«'ral occasinns exi)ectorated 
gave a history <»f bavin:; had jpiite a .severe attack <»f rheumatism 
iKick. A ])hysical examination was made and tlie following points oifa 
On insiMM-tioii ])atient was a^neniic: had lost considerahle flesh" 

marked flyspn<ea, incnsised on the slightest (»xertion, also r -* 

carotid arteries. On ])aIiuition there was a distinct 'S 




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MARINK-HKSPIT.M. SKBVICK. 



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J, H. <J.: a^f. •'■'• v>ars: iiHHvitv. MarvUiiul: H>liuitt<-(1 t-i the Unite"'. 
Miirilif Htmpital. BiUtiuicrt-. Mi\,. ]).i-~m\ir-r-i<. l!"""!: ilit-tl HweiuluT 37. 1 

//pViirtf.— Fmlur il'-iul: liitir-nnkii-iwn: ninth-r living htkI wc-ll: nevirl 
Itrothfr 'It Kistt^m. 

i^TJfojKi/ /im/oci/.— Tr.l«ii(-i. !iii<1 uli..!i..l usril in m.xli^rntiou: Uatl the iliiwt^ 
<rhi1(1h(>uil, pneninoiii» iri^Iit -,111:11 ;r'>ii<>rrl)t':i, thi' latter oiie luoiith nga AM 
iiiuntb HK<> WHS csiMffrt'l t-i ci.iitiiineii kill wiiitliiT fur tuiiDc tiiue. after wWl 
WNin dcvi'ldiifl tw" <'liil!i' iitirl liiiil rsithi'r M-vyre pain in left t-lieht. conpl-r-i " 
wiiiii) feviT anil low* <<( aiipftil''. 1 >u ailiniMiiinn tit hi«iiitnl. patient was iur 
Ki-ncml irfiiiilition. il(n-i<I<i1ty v-Kak and with innrkcd ilyiipnipa ami painiii™ 
itMiKt marked «vnr It-ft aiittriiir {■orti'm. TiiuiifratTin'. iJ:>,.|; iiulsf, I'W. 
Ii'hI o:(ainii]atii>n h1iowi>i1 tlio innviiu'-utR nf the client tci lie iiouiewhat 
i»hed. dnllnfwd over the l-ft (-lii-*t. iBriti-rlor, conplL-d witli diminished n_ - 
MnuHlfl. C^anliiic dulliii-Nt whh Iiict^iim:)!. jparticnlarl^ in a lateral diiodiK 
Hif apex van hiiaril a systnlir iiinnnur. 1il>m-inK in character, and t 
bi the uxilla. At tlii- eu.-<if(inn riirrilaKi* was neanl 11 Bofter Hy>-tiilii. _ 
Uvci" tlw aorlit; valves was hiiinl a diustolii' murmur, VLsiTile pnLwtii 
iihiiiily <.-viikiit in the iierijihwal viiwels. I'ulpation tihtiM-ed a 
Uorritnin piilw, fhi aiisi.-nltutiiin nf the camtidH. i*nlx:luvia,ns. imd bi 
il'inlili- tnnmiunt were hiiird. Nirtwitlu'taniliiiK tn-atnieiit the [latient «« 
to imiw Hb-adily iviime. thfi dyspii"-!» muru ]in>nininfed. tho pain miire sevw 
thii wt'akiiesKmiir«iiuirked, Death iviiue Bnddmly at 0.3.> p. m. Decemliw 

.\ii-,i>jHiy (/"iirl-iii hii'ii-K <ijf',' (/vii.'i'ii.— I'utrt-mortem firiility slight, 
miirtismarkid. GeTii-nd noiinshni«iit gnml. Circnlattwy or^jnnu": Heart.* 
«HI gnimit: left vent rii-li^ marki-dly diliitid: widls 1 to a (rm. in thickne^': 
vi>iitn<:1ealiv>enlarK<.-d anddtla1»^l: walls soniewhutthiimcrthiin left. B->t. - 
trii-lr-M riiiitaimil a iiimt-iuiirti'm clut: Ix'th anridra were dilated, the ri* 
twic*' itM nomiid cuiuu'ity: all tbf vhIvcm "f the ht^rt were inconiix-tcnii^ 
tativc nroccHsi-K pn'HiMitcd at the ii'-rtii; vahv: tlie aitrta and other ve,*stl; 
n11n11.1i. U«iqiiratjir>-organs: KiKht liiii;:, »''iglil, MTOfrramtt: coug«:t<Hl. . 
IniiK. weiffht. )<iiil fcnuHK: mnx'what ■•Mii;.i-t<>d. hut nut asiiinch so as right: >ii 
ajM'X iif thin ItuiK. ii'iir the anterior Iwinh-r, wiTi- four or five verv small t^Kii 
Uifflit i>l<ninil fHvity ciintaini'd 6-"iiK-. c. of wrunM flnid. The left pleiirali 
coiitaiiiMl rjiH) c. r. of flnid and ]ircw'nted a few slight ndht^ioiifl in th' - 
axillary line. Thu guiitro-int'f'tjnal fnut wuinuniial with the eiopptiim'^i 
Htoniat'h, whii'h waM dilalt'd. Liver: Weislit, :;,(Mm Rrnm^; (.'oufrestetl. """^ 
Right. wt'lght.3(rignini!>: normal. Loft. wi'ight, SOU gnima; cort«xtlik. 
I'lijiKuli! aiilii'ri'iit. IJniiii: Wcitiht, ].i'M grauis: diim mater Blinhtlv 
aliaiK th.' i-,:ntral jiiirt uf t\ir iwdi.iii fissuiv. ' 



Mit- 



rnimiy: was adinittol to the United i" 

-. o. r!il...luly-'i>, and dii>t\ An^rnst ■>. IM* 

iiii'iil Hi Hiik hiwirftnl from Ansnat liurf 

iiiii;Tiiir-c-.]i lln^rlilH iliM'aw, graimlar kidney. H " 

>wlliiij; nf till- f.,.t and li-gH and dyspntva on 
iiM'U.->. mill [>!i ,\ii;:u>t. ••: wan tapped and 12 S 
liinvii. Triiic wlmwid imlhing .iWionual. 8mIM 
.ti ^H-i.ti«iinT IT wiiH r'admitinl nuiler thoiS^k^ 
lii-..iii<-. III) <Ji-tolH'r 1;. IxtHi. was discfauKodi^H 
*i-limarr .'x. I I'lNt, and diaKiioMM mndc of TMlnBS 
(iliou. Ihii-Liiii-laimil of HVi-ellitiw of nnklw,- '^™ 
asaK" li'.iil.l.il with dyspno-a on exertion. 
■la ,.r lii.:irl iiiiimlM! iiirrHiwd. iind syst ' 
i-nl iiiii.n.wd M:iyli, ll"«). Wax admitted 
ij.insjv ,ii:i.li> .>!■ \ :il v.ilar di«'a«e of h 
^w<'lliii;r "1 ^iIiiIeiiim 11. iitikliij. and 1«| 
.Ih.\v.1 ]..iti..|it ti. l"M-y:inolio and-» 
hli'tid.il; I'likl.'s swiillr'ii and ^eia 
111; alii'iit ."> I'm. oiitMdn i>f nipple B 
ni;iriitiiiii'v Ihi<', Mjtiid n-gni«iti 
ivly hK.1: puliiioiii.-s.H'i>nd,a\KNlL 

ordinary tn-attrit-nr tur mitml n 
It! iroulini.tl tu hi.-! Iwd, i>ut on alL 




184 MARINE-HOaPITAL 8BKVICE. 

thoir «i])Ulanii( an- dirttcnrlccl with HtuKnutud Wood. Somo of the r1i 
flllwl with inwKiiljitnl iiilcmsitinis fliiirl. OtUers urn filled with e 
Iilood. TliH Htn^-iiiicti WHS taken fnnu tlie Iwse ot the Innif. whert- thi- tapt 
ciongOKtidn w;is iiiost miirkcil. *^ 

ILL 
B.LE 
J.il. 
Niiniiii of lH4i'k, i-iifviiliir ilUniHe iif Ihr heart , 'nirtii; ityetiiiioat. 

T. H.; aRf. ■-';!: iiiitivity. (iuoixia; iulmitterl to tlie United State Maria, i 
pitiil, EvanHvilli-, Iii(l.,.TiuiiiHi-y34, imd; dicclJnim&ry :;r, liwi 

;/i'h/w7/.— (.hi January- 31, IWII. lui wnx tr>-iiiK t<i Ket thf:! hcjiKtiuxenicisi' <!: 
IjiHit off ■■ il«ul centiT " by inilliiiK ">n the fly wheel. The ea^iu- PtartnlK 
fimlilcii jerknud ftu^-etlu) patlimt u Si.TiTO.ii'rkftiiil wi>en<:li. The nuoid* 
nesM iit tlio ninxclt-s nf Ihm Ixu-k, unnn, aiul riijlit Iiiiiiliar rngion iurrefuecl l«i 
whfii the boat ivtnnifil tiillilH city on .rantiiiiy -':). ItKll , lie wt-nt to li»h 
Uii tliRiicxtiliiy hi'c-nti'Ti.il the 1iiiH]nbil. The iiinHi-Iea of tho rc<>HiiiuaNik 
i»lMn-(t wero qntt« Ktfflf ami iminfnl, Hi« lioart tronhle Imthered hiinnot* 
In fai.-t, itwii^ a ty|iii;iil iii»M)r comjiewMatdry hyixTtrophy. imd then' vetrm 
inMvt! ff^pttmim't hfart tniiiUh' onniilaiiieil at. On the SHtli he had >1 
Thcninatic jiain in huth aiikl's, hiil; wHliniu siilicvlatis rvliert^ tlii* pun 
»pIwtitewn«iPB"lim<!lN'W(^l»w.n'n",{nlar. < >n the iiiomine of the ■'Trt i- 
Ix-tter, and ilnrina thi- iliiy wiit up iiml aliimt in an invalid t-liair. Intbri, 
n'lun after hi'in^ in the NiiK'khi;; room talkinK anil mnoldni; a cigarette (uril 
hfinrorwihomiiMcnlyfellimt i>r hi-: chair and w»r ilen^i before uiedicsl liAfl 
Iw jjiveu hiiu. 

.\'viii]ix!/ (iii'iKlifii liiiHi-n ii/lri- i/ii(»i).— BiMly well nourished. Pnpil* 
KiKor ni'irtiH well iiiarkeil. Heart: Alnint 100 1-. i: eli'nr Hnid -wan funod 
canliiil mi: Jleart mlanjp'l. Exturtial veiiia of heart enKorgcil Left 
hypertrojihiiil. Aiirtii: vulveK hml veKetidifns al-jng their edi;^ 
normal. Hiiirt w<'i«hwl r,n7 urMm. Ri({ht Iniig: Wc-ijjht, Ssr ii,„,„ __ 
IjOft ItinB; ■\Vi-iKlit, ■K'i Kniuis: normal. LiviT: Weight, l.TOO grtmuM 
c<MW.-Ktwl. irtherwiw! normal. Splt^n: Weight, IS.') (H'liiua: iiorma) Bb^ 
Weifiht. Iia Bttilns; iionaal. Right kiilney: Weight, 348 Knuua; normal 
Hilney; WeWit, ^'^(i (rranH: nuniiiil. Othi'r orKann ami tiasneti normal 

J.H 

J: R.: aKi','Kl; born in Tenn.'.ssei-; i-.jlor.'<l; aitmitteil to the Unitt^ Stiit«i] 
Hiwpital. Lcmisvilli-. Kv., .riinniir.^ IT: Oieil .lannary X'l, I'.Hll, 

y/(»/r. CI/,— Taken >irk Mi'Menly .m Hie l:tth jnHtant; does not think S 
hiulai'hill: felt wi-iik anil liailly ami ]i!(iii in rifiht riili': pn-vionaly had^n 
K"ik1 ln^allh. Tem^ieraliin- oji adniiiisiiin. ;!!».'!; pnlw, lUO; Binall wok.) 
compresMilili-. Iles]nniti(ni, 41: Hii]M-rti trial in charueti-ri <'r>iiiiilain8 'of n 
both ^ilh^i of i'hi->itan<l tiifpnit: contiauiinii hut not severe; IncreHsed br-- 
ing, OongliH little: m ilnll and wnnuok'nt, Examinatiuii shotvg npoer Mi 
rittht ImiK (■<m>toIi<latifl, with cnjirMu biiinuhinl bn-athiiiK and laoiatiAl* 
lower lolw <-onHoli[lati<>n i« al:-" jiroKn-'HHing. hh ivideiut'd by oreintaat iMi 
tyniiianic n'!tiinaiii.'e. Over tli>> b'rt Inni; ralex of viiryinv character aU^ 
are hfunl. Xointrlof itisi.-ons'.liibitiMt. Thu lower lolh.MMii became in IM 
Ciiliditiim HM the npiM-i-. anil all the liid Kymptoni:^ iuereiiseii, the natinll 
Rft.-r thii.<- ibiy, Allinm..|iiiriii fr-.m lln- l«e«inninK, i««-ii ^ 

A.rroiw// («/.!■ Ifi'-K ii/Irr ilmllih—iioily esi^.-ctUngly Kim-e, bat HH 
innM-hMl; cntanisniM I'ut almo>t entip'Iy abw^nt; ri]^>r innrtia modei«t«, ' 
men: thii^'ntnni aii.l alKlouiiiial cavity Ittv from fat; inteetines «■ ' * 
ext end K <'.-■> em. 1h>1"w tbo nbs: deei>ly conKe^li-d: iwwwive: welKlu 1 
(Jall bladder ni.Mlerat.lv full. .XiijieiidL^: Nine cm. in length^ 

ward into the iH-lvi^: im i;'ll]esi..n^: bus nies'HipiM-udix. If " 

ciilarK.'il. SiMiiiinh eniiity. I'.Tieiiniiuni ailhen-Mt, iini»L . 

alisobilely no iieriiMr.lial eiivirv. ('..nilitiim >'f lonti Htanding. 

rtialiited aii.l full uf bl.-Nl Hots: lelt traded. With the — 

Valv.«inliii-t. Weiifhu-JtOKi'imis. K.itaiiurtieleof fat on. 
(■nilly adliirent: iiraclically all of it in in ii Hliite of n-d. or 
Hiiiall )Hirtion at the Ikdn,- in fnint is nnmh weitihH 3.14(1 gnu 
adbiwioiH t.i tileiini. and wimo li>-uostati<; cotiKeiition of pob 
WiuenDnual, Sjdei'n ttmull and dry; llUKrauis, There Is 




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136 MAKINE-HUSI'ITAI, SKRVICB. 

hilar tisinic nhont kiilnpys iHleinatonB. Blntkler contain b a feir ounces of iri 
Stoiuttub mill intestiiicH tilif;litly iliiitciiduil with ){iis. Appendix loDg; itiiB 
soft y(.'1li>\vi[iut<-riHl in sniiill uitii>iiiit. MciM-uti'riu Klands not enlarfcetl. F 
crwus present no aliiioruiiiliry. Wvci-. ]iir|^i>; wi-igliH 3,40() k''"ii»<- Siuidl hm 
rlmific iiifnri't cm Kiirfiicu of li<ft lulu-. lt:< cut HurfHfe in sUKhtXy y^ . 
yellowish iik liiic, CJiill bliuldrr ^Imiit lini'-tliiril full. No bilf cunlil be^ince 
throtiKh tlie ilnct, iilthciTiKli iii> ulwtnictiDii u'uh visible. Bruin anrl spiualc 
Dot exiuoiiietl. 

A. 51.! 

P. H, F 
Ariifr hftmr iiiieiiiiKniiil. 

D.H. (colored); age.an: imtivity. KciitHiky: udmitted to I7uit«><l States 3bi 
HoHpital, Lmiisvillu, Ky., Fybniiiry 'J:i. IH(H, iit ll.yOa, in., and (lie<l at B.-Wp 
the same day. 

Hisitiry. — Waw in an nncunnr'iim.s i-onditioii when iulmitt-ed and never ir^ 
conwriirasuBtis; t<;iiii>eratiiiT. :l!l.li) C; inilm'. Hiii; vpry hard to connt: theri 
IniiKcnnHolidiited; left, tivtr. r<'»]iirji1iiiii, Jii tu'l.'i iwr uiinnte; very sba11(iir. 

Aiil-nMU {f,n;>lii l.uiirs iifl,;- >l,<ill.). -A iii-Ki--., nifdium siae, njiftre, fairiy 
nonrished. Tlionix: Pcririii'diinii cimtiiiii.s To cc t^lear fluiil. MMirt in diis 
the coronary veins rtistt'iidcd with lilncid. iin Jire the anriL-lus and ventritles. ' 
right ventni'lo contiiiiia ii htr^'e white vlut. Weight of heart, IMW Krams. ' 
right lung itt I'uvered by ii nveiit. suft. filtrincnw exnd»t<.', nnd is entirely too 
dated oave for ji siuall ari'iiat tliulKise. Thui'iai!«ili<lafion (.■ouRints of gravb 
tizatioD alM>v(' iind red hetiutizutiim IhIhw. Weight of right Iiuig, L.'iOwVi' 
The It'ft Imig istiigorged with IJoml. not iiilhcrent and not consolidaW. 
weit^hs III)') grninM. AMomi'ii; The liver is enl urged and conK^Hted. and vcj 
a.5(Ki grains. The gull blaihWr was nniity. Venniform apjiendix, lai^.l 
has meso-appenclix. ]Kjints upward iiiul ucnis-i the brim o^ the jMslviit. Thed 
organs were not exaiuinL-<l. H B.i 

M.E.< 
J»/tiiriizii: liilmr piiiiiiiiiiinn: mu'MiirditiK. 

T. L.: age. S3 years: native cif Kiitisas: nduiittM to the UnitPd States Ua 
Ho^itttl. Cairo. Ill,, .Timniirv in, mill: dii'dJiiimiirj- 22, 1901. 

Hiiitvrii.—T\iin jiiLtii'iit hull :i t'liiU five diiys ugi>, and baa hiMl chilly sensat 
eiiice then iit ^■a^ions times, lie CDinjilains of [mins iu Imt'lc and limbs, i«rl 
larlyinkni'ejoints. bnt thi-riHs no awelliiig of hitter. Coiniiliuus alttoof anon 
nausea, and rimiiting. Ihin t>.-nii>eriitiire of 40.1' C. Says he has no paina' 
cbext. Has heiulache. He tiotlees ]iiirtieMliirly itn overpoweriug sense of « 
nenH. (.Tiven etiloiuel in " broken doMii," followed Iviwliue. Ordervd aodii 
soon .ni gtn. II. B h. <.>ii evening of January 1 1 bin iiu» was flnshed, mtdn 
iniTeafleil.imlseiu^ci'lerati'd, full, and fining. Hluirtcongli.spQtiun blood Btai 
Ho K'deH nndilJe. Qlven hhihU doH-s of iK-<>nltu and lielladonna with spts. otl 
nitroiii daring the night. Iliia luid no ebill sinei> lulmlssion. More marked 
dfneeof pueuniimia on tnoming nf .liinuary I'i. l'^i>(>r and middle lobe of i 
Inng involnil. No v!>lviilar lesion of heart: no tx'riiriirditis. Onality. rate, 
rhythm of jinlxe out of ]ir<iiiortii>n t" Inng involvenii'iit. Heart laboring un^ 
MyiH'ardium iirolKibly atrutely iiiHiLiuMl. It tinct. digitulin .1)2 cu. q. g h. tti 
oitii -ll'i gui. at bedtiiUH. Fliixw-ed iiunltii-i' ovor heart, renewed q. g ^. ^j 
night. 

./r(M.n((v/ ;.;.— Pnlw |:!S; w.Tik, irri';;iiliir, iiiid intermittent. Slept bnt I 
(t inor]i1iiijii- snljibas .01 gin. ;it bi'drinn' iiisti'^id i>r ]iiilv. o)iii. 

Jiiiiiiiiru AT,— Pnl-i' sx this nLin-uini,': Hiri.iijifr, m.ire regular: still intermit 
although h'ss often ihaii hrrtTtiifiiiv. Digitiihs ili.-<<-ou tinned and strychi 
t<iill>h. onleri.'d. that Iln're ijiiiy 1h- Injietit rniiii ri'siiinit' >ry as well as cai 
stiniiiliLtioii. 

Jiiiiiiiirn /':■,- Piiriiiiicrtiiii i-risis iiiiii-i'il, Teiniii-nitnre normal this mon 
Pnlse t^li-!K{ all diiv. K pniliiiibvlliini n'siii .HM gni, iit one done. H malt ail 
l«w. 1. 1. li. "—I*™ 

Jiniiineii 11. — FriOs very t.ianliirl:Ll.]i', Dciin^' iiicrly. Exjtectoxi 

JiiiiHiiri/ /,''. — Pnhnoniiry f"iiditiiiti ni>w nf s.'cundary iinportancL, 
ia diM'outiniieil and tinel.digilulis ordered «g:iiii..4M i-u. q. 3h. . thnt ll^™... 
may hare as iiineli rei-t iis {Hiiwible. IIiis Ji-^eii feeling very wc<U nil day. 

•/((MHtirjV -'''.— CousliiKited. H ]iulvis effiTveseens nompodt.nB. sa jy^. 
rejieatMl aftor au Iwmr if ni-wssnry. Resnlt siitisfautory. 

■hiinnivii .:i. — TeiniH'mtnre normal and iiiili«e iininored laat two, i 
fueling and looking will and comfortable at morning id — ' ^ 




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138 MABINK-HOSriTAL 8EBVIOE. 

L<ih(ir jUfciimntiifl. 

R. T.: ago. 2i\ vears; nativity, Teniiftiwce: afliiiitted t<.> United States M 
Hospital. Memphis, Tonn.. April 1, 11)01: aied April 6. 1901. 

Hislorii. — Was oxpostMl in rain all day on March 30: on :Jl8t ha<l sevt^pe 
followLMl l)y fever, pain in left side, fough. and expecitoration of blood-sen 
sputum; some diarrhea; no api>etite. ( )u f nil ins]>iration sharp pain in left 
dullness on percussion over h*i't lung, with bronchial breathing. Was tr«« 
with lii<*cough almost from beginning of attiu;k. which was difficult to relifi 

NvrrnpHif (si.rtrcn. Innn-s tiftrr thttth ) . — Bcnly well nourished; post-mortem i 
ity. Veins of meninges of brain dilated and filled with bUxHl, and luemb: 
adherent along both Hi<les of great longitudinal fissure. Wei^jcht. 1.26(» p 
Left lung: Weight. 1.800 grams; i)leuritic adhesions firm l>oth to chest wiSi 
diaphragm: lung in. stage of commeni^ing gray hepatization. Ri|i,^ht Inng: Wt 
590 grams; hyi>ostatic congestion post«'rii>rly. Liver normal; weight, 
grams. Heart: Large chicken-fat clots in all cavities, esixjci ally large •■n 
side: weight, :r)0 grams. Spleen normal: weight. ^40 grams. Pancreas iwj! 
weight, GO grams. Right kidney normal: weight, 190 grams: left, weight 
grams. 

G. M. 

J. T. (negro); age. '3:j years: nativity. Pennsylvania: admitted t<» mariut* t 
Mercy Hospital. Pittsburg. Pa., May is, UM)]; die<l May 2.S, 1901. 

Ifistoi'f/. — Patient was tiikeii from his boarding house to tho hospital ii 
ambulanc^^!. Stated that he ha<l ix't^n sick for four days. Sickness folloi 
severe **<told.'* lM*ginning with a chill and accompanied by a severe cough, 
pain in the right sidt? of chr-st. On admissi<m to the hospital his teinpen 
was 40 (\, his i)nlse ]'2'y per minute an<l very feeble, his respiration 52 per mil 
Both lungs gave a <lull percussion note all over, tactile and Vfx^al frcmetnsl 
greatly increascMl. Bronchial breathing was marke<l over each limij auter 
and posteriorly. Under p< >wi.Tf ul stimulation his condition improved, the rw 
tory rnt*i being reduced by the third day to 'JS jier minute; pulse, 100 periuii 
stronger and fuller. TemiK'ratnre then 3S C. This improvement coutinne< 
a day, when the temperature ros<\ and with it the re.spiratory and pidi^ 
Patient iR^came w<*aker and weaker, dying at 7 a. m. May 23, 1901. At no tim 
he complain of pain in his abdtmien or (jf diarrhea. His bowels were m 
regularly, and there was no abdominal tenderness when first examined. 

SWtu}]iSi/ iiiiiH' hnnrs <ifti r (hi(tli). — Body that of a man 1.8 meters tall: wi 
alKjut 72 kilograms. There is no post-mortem lividity, nor is rigor mortis 
develotH^d. Muscular devcloinnent poor. V(?ry little subimtaneons fat. ', 
pleural cavities an; obliterated by recent adlu*sions. The ris^ht lung weit^ 
grams. Tt feels hard thrnugliout and on section l(K>ks like beefsteak. I 
rM)zing. The li-ft lung weighs 1 .Tio grams. It is not quite so solid as is the r 
but is infiltrated with pusabcnit its base. The a])ex is slightly crepitant. ' 
lungs sink in wat«jr. lb*art the size of patient's clo.se<i fist. It is stopw 
diastoh;. Valves competent. The liver is slightly enlarged and congestcuL 
the spleen. The kidneys, jiancrefis. bladder, and brain present nothing woTli 
note. The veniiif(»rm appendix is whitish, atrophied, flattened. It is ^ 
long, and on section its walls are extremely thin, t\u' lumen barely admitting 
head of a pin. In the il'um. about 10 inches from its union with thecfecv 
seen a retrogratle intussusception fully :j inches in extent. The intestii 
that point se«'ms to be j-oinpletely obstructed. There is noiuHamniationorQl 
ti(m of thr* intestii H's in vol veil. Then; is no fecal concretion at this point, i 
there any accumulation of feces in ihc .ie.iunum or upper ileum. 

R.C. 

I iijlinii^n: jm('i(t)iinii(t, Inhttr. 

(t. M.: age. .')<;; nativity. New York: a<hnitted to the Unite<l States Marine 
pital, Boston. Mass., January HJ. r.JOl: difd February :J, 1901, at 1.30 p. in. 

///.sYri///. --On entrance ]»atient coinijlainid of cold which he had had far' 
wer'ks; within ]>ast few days had been sufifering with pain in limbs head 
cough, and .slight chills. TeniixTatur.- afternoon of admis.sion was 38° C. Ej 
nation reveal* d an occasional dry rale ov(;r chest anteriorly, with slight C( 
A diagnosis of infbienza was i:iade. Witiiin 1 wi-nty-four hours patient *sti0i 
ature was ii'innal and ranged In'tween :\(\J\ ( '. and .J7' C. until ^^nnary 28/ 
it .showed slight rise. Pains in limbs disapjK'ared and cough was sUght 6 
evening of January 22 there was noticed a rise in his temperature -of .2* C. * 



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]4r» MABiyK-HOr^PITAL SEBVICE. 

' / ' . J ' . • . ■■ r . * - ". : J h * ". V ■:•'.: ri ■>'»-• t. : ^-h* an-l is v^ry i\-rnl e^* rhi* iii' ■» 

.i/" . !>* -!i:. — r. -v.; ■:•-:.•:- ■■v--r ' .- • !.*:r- ri^hr Iui-lt. T«rni:"-ratTir»-. ; 

;. *.-•: 1 .''i, '*;. : r--: :r ;': .:. - ; •. T- ■ :.-.;r" * ■;:.■'.* arr I"n«i rtii«i cl-r^r. Thr.- 
v.:jr.-l '.V- r *r..- ;■ i".. : ■.:.- ',:r''r.- > •■•-:. •";iV-i. 

.^/■V . ■ N I :r/.: r ■ - 1;.-.* -::. ■ i-i-: :.■ 'r. 

l/.i./. T'::.;.»rrt* ;- ■■ •;■• ' .. j.;!-: !-■?. w-ak i»ii'l 'lii^r-tric: nrsj-initivi 
i'V ;■•?.• 'i>-'l ■i..:'> . . I:... M;iv '■:'.. 

^." I'ni'f ■•/'■' .i nr*. .■ .h.iTi. . — ri*i::h:. I.T** iii»-t»-r:>. Pi>?T-T3i'.rTrii: 

ir . I..,' a;jpar-!it :.-L'r-.' : rij"-:' i-.-rri- iiii.irk*-t:. •T-.-ri»-rn'i L:«.tir:-hui-Lir jj 
■A'»''.l'j V. ; :•:;. i.-.-.T-'iiiir iii;i:.. p-:j'i!- .-*.::r}.rly ililat*^!. Htrart: W-iirL: 
'»j*''/.::.-'. ..■■' jr-i*.:-: '. iiiv'- • •.::.|. -vii*. ..-•..-r'A i— i;.inu:il. Pfri'-anlial :vi'.- 
in;i!, "ti.',,\-.'. I. -n.'jal rtui'l. L- :r V'i::r:.-*.-.' •••:::«'] ?is tinn iNia^nilii. Th- 
'•h;ir/i'^ :- ;'r- '^-r-f.'!'-'! v.'irii i\\in. t-ii;; •■:-'i- fiaj-ul-i. wliich ^rxt^-iid iut««Th' 
-'■1- -.'.ip'-. !>kry!j.i.aii'lr.r.i'L' 1 1. ri::!'. LniL'-; L*r:t. w«fi;rht tiihi ;trratnji,i,..; 
\f\*\T:i\ '■.:•.": \.',r:iii\.: r";.'J:*. v/.'l'i.t 1.'.«. » -jriims. Thetriitirelnn:; Tscoii^iIM 
I'r.'r •;.-.-■. • :-. r«'l'Jirh->i:'rA-!i ■ 1 .r. :ir?.» ;.:;'! f»:rl»'si>. <>i.sei*Tion th»^ siirfaiei? 
fri;»M ■. a:.'! -'."aT.'ilar: j.!' iir;i; • ;iv:* y f Ti*:i:ii-; a small quantity rif bli>j<l->T; 
-<-rMiM. aij'l :- a-iii'-fij' : • 'i.'-* '.v;-.!; li%r.iily. (Ta.-tri»-iute>tiiial tract: Tvi 
ji)i;»ryiiA. iwA «i'-'f;.ii;i/';-. ii'.ri?..ii. S?"iiijiiii fi»ii Tains coagrnlatod luilk. 
inM'-'Hi- in«-rri!»riiip- :- >rny iTi ''tl-iy, wirii j.^iiiitx nf e';r]iynn.Kis. The wall 
••/lii'rv.iijt thirk».iji-.; ju.i] ;},.. ruLra- iiri;iniii»-iit aiwl riilar;^tsl. Pylorns au«l 
'lia*' ''T\i\f' II' ir II j;il. ."^Tunii ;i7j'l l;irji- ii;r'*>tin»-s <lisTt-mied \rith jjas: re 
ii';n/jaJ. IJv«T i- «-ii];ir.r' '1 a?j'l -'iii.»-\vliat >!l»-rnst-d: c'>»lt>r. lii^ht l»rown: w- 
o.r.V* j.'rairi-, N:ill ]*l;i'1'l'r ai.'l 'l:i<-t> iii^niial. Pamreas." wei^bt fUi gr 
T!j«r;<l;iij*l i- -o]ii"wlj;rt firi.'i«rrli;i:i u-irinal: ]in«]paMy an ovfrgrowt h of the til 
ti--ii»-. Ki'lii»-y.-: L«-ff, W'itriiT I"*:' ;rraiM-: an<l rijrht. weight 15*2 ^^rauis. 
ki'lii'-y- r:ori;.'«-.t«rl, P«lvis ain] r.ri-r»T< iionnal. IJhulder. urethra, ami im' 
riorin;i1. Sii]inin;na1 lM>'li»>: L'-ft. wi-ij^bt 4.'i ^rrams: right. "Weij^fht 4.5 gr 
f« f\ur . Ti-f\*\\Ai-y*'Wu\\'. Sj>l««'n. wi'i^fljt IT") ;.'Tams. nonual. Scalp and sknll 
ni;il. .M'rr/il*rari»jH of bntiu aii'l Ili«' lirain normal. Brain. \reif^bt 1.4'i4 pr 
Otli^r or;canM not ♦jxaniiiurl. Mifro-mpiral <'xaniination made of sxieciinens : 
liifiir. liv*r. ki'liH-y, and jpanr-nas rliv C\ U. G.). The Inng sho^red its al 
fil!«-i| with fiu i'Xii'lat*' of *-iiitli».-lial «-*ril'- and fibrin. The Jun^ tissue can sea: 
Ik? d<'iiion«tnif»;d. Xo \^ni•n\wy(:*^<'(•\ w«.iv found with Gram stain. The kii 
Th'- ♦•jiith'-Iinm <if ni;iny of tin- tnhuli'S was dcr^cpiauiatod: the tnbnles filled 
f^rarinhir d'-t ri tJis, fn '-«*v<ral ])lar»'s w»- find hc-a^w of round, inflauimaton' < 
Th*' }»Ioor| \i'j->i.]f. ari- ♦•n'j«ir rid. Th»* liv<r.'^liowscoll<M*tiun «>f inflammatorv 
aroiinrl \«-h-*-N, Tli«-n* is a s1i;;lit inrn-as** of counectivo ti»«stie. The liaiM 
nfiows >nnH* inrn-a.s'r of (■onn«'fli\>; tissue. 

J, B. 



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iin.'.i ii;.nri I. .ihii;;. :iii.| tii- iiii.r. ■-■.■!"■ -!i.'«-...| ;i l..i^-i> immlxT of hvulin*»« 
r-.-lv >:r:.:,:,!.;r >■;.-.(-. Til.- i.tn,,- w,i, i,!-.. .|nii.- »-.niy ui :.TH,„iut. Deapitoil 
iliiii-iil. th.'i>liv-ual si:;iis lH,:nn.> lil'-r-iii:irki'.l: tli.- luitlt-iit Slkuk dMrprrW 
■l>'Iii'iiiiit.iiii'rili<' urine !>till •->>iiiinii<''l M-uiiiy. Tn-iitiumt t-onslsted of &i 
lUiliitiim Willi whiskv. siry>'Iiiiiiu-. l<H-:i1 uiiiiliciitioiis. mid food. OBtttB 



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144 MAKINK-HOSriTAL SKRVICE. 

('hnmir colitis: (trtrrin-fibrosis: jnn'iiimtnid. acute lobtir. 

(.'. P.: ii^'»', 40: nativity, N»)rvvjiy: last tiiiployt'd «>ii scluioner -lahn i\ lieark 
Admit t(.*«l to United Statt*s Marine Ilospit^il. Stajjlcton, Staten Island. An^nuit 
IIKH): aUnl XovemlH-r II. IJMH). 

FVi III a If h istori/. — N<';^ativt'. 

I*ftst hitffnrif. — WliMi IS yoars of a;?(? was ill for six luontbH. CoinpL-iined t 
of i>am in stonuich. which was relieve*! by eatinj^. of anexoria. emf^sis, etc. E 
years a^o, while in Xew York, had remittent fever and has hatl twoortl 
attacks of malaria since. Had rheumatism. K'>norrhtea, and hard chancre, 

I'rrst'iit InaUtvif. — Has l^een sailing alonj< the coast of Florida fprmanyw 
For past two years had suffered with i)ains in stomach, which l>ec*aiue !«o iv 
and were ar'tromimnie^l hy such preneral weakness that he left his vessel JtiIt: 
i)res<'nt year and has lH*en aslioro since. Pain l>ecomea intt^nsific^d three or f 
liours after <;atin)<. is sharp aiid cramp-like in cliaracter, and is nsnally 9i:y. 
pani<Ml with des^^ire to K*) to stool. Althoujj^h at times constii^ttHl. as a rule J 
diarrhea, the stands Iwinj? fluid, small in amount, and are not attended witfcs 
tenesmus. Pa.sses sli;<ht amount of blrMwl at times. Has eructations of gasd 
acid ffKxl. ()x\ I'xertion suffers from dyspncia, vertigo, and liesidaches. 

Pltifniiuif (wtiniiiiittinii. — General condition i)oor, is anaemic and emacisti 
Cliest ne;^ative. Alnlomen flaccid. <.)n x»alpatiou considerable giirglinK ftE'l ^ 
deriii'ss (flicnted. T(?ndem<*ss mo>t marked aloni; the transverse colon, esjKi-ii 
in tin? epigastric region, Avhere a tumefaction may lx> mapi)ed out which is* n. 
ableui>ward and do^\'TlAvard and transmits the a^irtic impulse. On aui^cnlrjr 
over tliis mass a bruit is heard: on displacing mass from aorta an impnt* 
bruit made out. The superficial arteri«'S show advanotnl atheromatus chanj 
Treatment: Milk diet, intestinal antiseptics, and astringents. Temjieratnff 
admission, il'.>.2: respirations. 2S: ]mlst\ S)<>. 

(h'hybn- :n. i:»ni), — General cmidition not improve*!. Has lost considemhle f!^ 
Diarrhea persists. St<Mds fluid, small in amount, of greenish color, and f*r 
Tem])erature and abdr>minal symptoms much tlie same. Appetite good. Tk 
pjvature became normal the tliinl day after admission and remained so for five 
six days aft4."rwards. Ifas been c'.)mi)laining of cough and has lunco-pamV 
«,*xiK*ctorati(m. Examination of lungs shows dry stage of hronchitis. msiv 
re<'eiving increa.sing df)ses of i)otasMum io<lide, but they have been discontimr 
Given si)r€iy of wine of i^M'cac and water. 

(h'ttibrr .:.\ I'.iuti^—lliiii ciiill at 11 p. ni.. followed by fever; temperatnre t?^ 
up to '10.(5: pulse '.M): res])i rat ions :20. Given quinine sulphate 0.6 t. i. d. 

Or/r;/w/-..';.— T«-m]>eratMr»' normal yesterday; pulse U*J: respirations 20; diarJ 
same. Coughs (tonsidi-rably, with free muco-]»urulent expectoration.' I« w 
weak. Has pain in right side of chest, especially when coughingf. 




jM»>ilori<'S of (jpium, iodnforni, an«l tannic aind. 



\in't ihIh r Ti, I'nin, — (General condition mutrh worst^, more emaciatefl. nenoi 
and ana>nii<'. Diarrlica lesscni d .smiiewhat. (*ramp-like i>ain8aiid tendeniei«> 
sosiViTe. TmiiefactiiMi m alxbimcn lesscnt'd a])|)arently. Coughs considenli^ 
expert oratiuLT cou-^idrnibly. expectorations being bronchorrheal in chaxw:^ 
K.xaniination tA' lini?< slmws funsolitlation ovt-r right side. Teui|ierature nu 
fr(»m normal to :'.x.."). 

.V"ri /I/ /n 7' /■.'./.■"'".-■('« Midi tioi I iriucli Worse. Has l>e«*n ri.»ceivinf; stimnlai^ 
conMantly. Diarrln-a al>onr t.ln' sanu? as l;ist not^'d. (Nm^h still troableMO 
with i)riifiis»' c.xptTtoratiiins. 

.\nn mill r /',. / •■ " - r)«'s]»it«' incnsisj-d stimulation Iw gra<liiallv sank. [< 
nioTiavy odiina s»ttiii:^ in, mid lie dicil at !)..V> p. m. 

.Vi«rfiy>.s.7 y.<i.rl,,i, li.ims nj'trr (ti'ilh).- I>f»dy of a male, agod about 40 VJ* 
('oiisi(l»'rably i'iMa«iat«'«l. Kigr»]- iriortis fairly niarkrd. Slight sugiHlliitiniB 
«|f|M'?idint pnriiniis. l\v»-s gl.izr.l. Piiiiil-! niod«'rat»'ly dilated. Anterior v^ 
asiiiiiiiii i:<inn:il. Tliyiiiiis not t'')und. Pericardium in nonual ]'M>sition: oontfl 
;iJiiint •.•■"» ••, c.« if i-lfiir. stniw-rolnred .<»'rum. WjiIIs smooth and ^listeninir. H** 
Lrit v«-iiin«l«' avn*>t»'rl in ■-vmoIc; riglit eiiiit;nu-^ slii^ht amriunt of fluid blnnd* 
M»nn' cliiitcii IiIikhI. Kii,dit: ani'ii-b' cnuTains rnnsiderable clottcHl blood V^ 
pubiioiiiiry art<M-y. \oriir vji1v«m nnipcit-nt t • w;it«'r t«'st. Some c*4il careens dif( 
its at ba'it'Siif valvf flajH. JMitr;il oriticr ad i nits two an<l one-lialf flniren. Vrf 
edges con.»jiderably thick* -ned witli calcareous tleposits. Heart ^nna ffe abont^ 



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146 MA RINK-HOSPITAL SERVICE. 

took change for the worse, pnlmonary (cdema set in, ami despito stim 
rapidly grew worse, and he die<l at 6.iM) p. m. 

yrcropsjf {tu'ettti/-om' hours afivr r/r((^//).— Rigor mortis >v ell «levelf 
mortem 8uggnllatiou.s marked, pupils moderately and evenly dilute 
amount of subcmtaneons fat. Anterior mediastinum contains fat. Pe 
normal in appearance and contents. Heart: Left ventricle iirrrsted 
and empty; right arrested in diastole and contains dotted blfx)il. ^ 
great vesstds show no abnormalities. Heart muscle fairly finii: co 
deposit of fat on surface; weight T).")!) grams. Left pleura: Surfaces 
one large fil)rous adht^sion at hjise of lung. Right pleura: Many adl 
diaphragmatic and parietal surfaces. Lett lung: Weight 1.440* gra: 
lobe in condition of red hepatization: lower lol)e congest €»fl and a»« 
Right lung: Weight iMM) grams; all 1o1h»s congested and oedematons, 
the lowest one. Omentum contains much fat. Sx)lei»n: WeiKlit 140 gi 
sents no gross abnormality. L( f t kidney: Capsule strips easily. Two 1 
and several smaller ones visible externally. C -ut section shows indisti 
ings, grayish apiK'arance of ct)rtex and medullary l)odies. Rijifht kidne} 
295 grams: resembles left in findings. Bladder contracted: mucous meuil 
geste<l and rougliened. Rcnrtum, stomach, dujKlenuni. and intestines 
tive. Liver: Weight 'J.O.")!) grams: tissue friable: cut section lias a 
ai)i)earance. Brain not examined, as friends claime<l body. 

J 




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140 MARIN Jfi-HOSPITAL 8EKVI0E. 

Mdfl /';.— Patient slightly (lelirinns last night and is very restless this inon 

Mttij :<. - Dullness n< >av (!xt ends < )vcr 1 lie enti re right lunp:. Tem|M»ratarH, :\ 
pulso VM'k ainl respirations 10. Tli<^ heart sounils are loud cin«1 cletir. These 
sound OA'er flu? jmlniunary arhTv is aceeiituated. 

Mtnf ..".». — No im]>roveinent since last note. 

Mil I/. if/. — TemiH.Tatun' ;U> C, pulse ri>3. weak and dicrotic: r*-spirati«.»uj 
Patient died i}.M) a. ui.. May :»1. 

Nrrrojpsf/ {ri(jhf hnnr.s (i/hr (hath). — Height. l.T.'^ meters. Post-Tuorteni I 
ity not apparent (negro): rigor mortis marked. (Teneral iiourisliiiient ^iifi 
well-develo|w.Nl , muscular man. Pu])ils slightly dihit^^d. Heart: Weight i 
opeiiing, oM) grams: valves cnmpetent. otherwise nonnal. Pericsirclial s^u; 
mal. contains normal fluid. Left ventricle contains tirm coa^ila. Th*- r 
chaml>ers are distended with finn, t<»nacious coagula, which extend iiit^» tin.' 
Ktds. Nares. larynx, and tracln^a n* »rmHl. Lungs: Left, weight (»0< > grjuns. non 
pleural cavity normal: right, w«'ight 1 .IL'O grams. The entire lun^ is ccmsoliiLi 
The tissue is roddish-browni «-olor. lirm and airless. Ons(Hrtioii the surface is" ' 
friahle. and graiiular: pleural cavity contains a small quantity of blcKxI-stai 
serum, and is fulherent to chest wall laterally, (lastro-intestinal tract: Tan; 
l)harynx. and (esoi)hagus normal. Stomach contains coaKnlated uiilk. 
mucous membrane is gray in color, with points of ecchymosis. The wall-; 
somewhat thickened and the ruga' prominent and enlargeil. Pylorus ami > 
diw. orifice normal. Small autl large intestiiies distende<l with ^as: rei-1 
normal. Liver is enlarged and si>niewhat sclerosed; color, li^ht brown: Wf' 
8,*2r)() grams. (:Jall bladder and ducts normal. Pancreas, wei^lit 60 gni 
The gland is somt?what firmer than normal : iirobably an overp^'owth of the fibi 
tissues. Kidneys: Left, weight \^h\ grams: and right, weight 152 ^rams. I 




Scalp 

mal. Membranes of brain and tlu? brain normal. Brain, woi|ifht 1.424 gw 
( )ther organs not exiimined. Mi(!roscoi)ical examination made of specimens fi 
lung, liver, kidney, and pancreas (by(\ K. G.). The lung shoi^ed its alv 
filled >vith an exudate of epithelial (.-ells and fibrin. The Jung tissue can scar 
he demonstrated. No pneunnK'occi were found with Gram st^iin. The kid! 
The epithelium of many of the tubules was d(»s<|uamate<l: the tubules filled i 
granular d<'tritus. In several places we find heaps of round, inflanimator)' o 
The bl(K)d vessels are engorged. The liver shows colle(ttiou of inflainiiiator}*i 
artmnd vessels. Tht^-e is a slight increase of connective tissue. The pane 
shows some in<*rease of connective tissue. 

J. B. 

Pminnitnitt: iinrnlmf j)rric(i.nlUis. 




ueiirinm luarKea. iMarcii ij iiie ]);iTieiir iias sijnis oi cons<Miaation in lower 
tion of left lung: tlie foll«>wing day tb«' ex])ect oration was nisty. On the Hli 
])ulse was very w«'ak, tlu' respimtion more shallow, and the delirium «"«^ 
Tem]M'rature then Avent to 11.'.' (\, )»nt was redm-ed by several sponge In 
which also .^eemed to lietter the general «-onditi(ni slightly. March 16thepat 

noor 

r 
P 

cardial siic thickened: contained ';;oo c. c. purulent fiuid. Nares, larynx, and 
chea nonnal. Lungs: Left, weight J .'J-io grams. Whole lung^ preseatodflfl 



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142 



MARISE-HOSPITAL SERVICE. 



jjn-atly iiut<iui'Utt<l liy emli iiisiiiratimi ami i-spiration. In a few honrs then- 
in 11 luiinfnl. Knp|ir«Hiwil cnutrli. wliicli was iio'oiiiiiHiiiod by mraiity, blwjJ-<tiii 
exiH'ftoratiim. Tlic (irst Mjuitii fxainiin'il «li"Wi-il tlie (■luira'-t«Ti8tio riisty linp- 
Iiiii-nui'inia. ami wen; so cisi-id tluit. tlieir <'iiiitaiin'r conlil lie invert<Hl witir 
Binllinj; tli^'in. PhyKical cxiiiiiiiiatinii riA-caleil dnllncsH f>VPr the Ikist uf b: 
Iniifp. l''wt<;ri(irly,\fithbioiKhi;ilbrpathiii8an<l'repit)iiitaiulf«iiietiini'SfWiiop 



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146 MARINE-HOSPITAL SEBVIOE. 

took change for the worse, pnlnioiiar>' oedema set in, and despite stiinnla 
rapidly grew worse, and he died at 0.30 p. m. 

Si'cropsy {Uventij-t)iii' hours (iftrr (/((//A).— Rigor mortis well develoj*^ 
mortem 8uggillati<>ns inarke<l, pupils nunlerately and evenlv dilateil. 
amount of subcrutaneous flit. Anterior mediastinum contains fat. Ptrics 
normal in api)earance and contents. Heart: Left ventricle arrestee] iu 
and empty: right arrest^'d in diastole and craitains clotted blood. Vah 
great vesstds shoAV no abnormalities. Heart muscle fairly firm: amy^v. 
deposit of fat on surface: weight H'iO grams. Left pleura: Surfaces nn: 
one large fibrous adhesion at Inise of lung. Right pleura: Many adhe^d 
diaphragmatic and parietal surfaces. Left lung: Weight 1,440 gnun.<: 
lobe in conditicm of red hepatization: lower lobe congested and ue»ien 
Right lung: Weight Imk) grams; all lol)es congested and o^eniaton:$, esr 
theli) ' '" ^ ^' - r^ ^ ^ «-. - ^ ~ 

sent** 

and 

ings, grayi.sh apiK^aran<*e of cortex and medullary lK)die8. Right kidney: ^ 

295 grams: resembles left in findings. Bladder (*< >ntracted; mucous membra 

gested and roughened. Rcjctuni. stomach. du<jflenuin. and intestines ar< 

tiA'e. Liver: Weight 2.050 grams; tissue friable: cut section has a vil 

app<»arance. Brain not examined, as friends claimed bodv. 

J. Jl 

Pnruntnuia, lohtr, 

J. K.; male; whit4'; age, 5(J years: admitte<l to Tnited States Marine H< 
Detroit, January 20, 11)01; di<^d January 24. 1IK)1. 

Iliston/. — The patient, a fireman on theU. S. revenue cxitter J'cwtmdenMi 
he had l)een a hanl wiirker and a hard tlrinker, had never previously stLffer? 
any severe si^'kness. His family history could not be ascertaijieHl. oii thee 
of *Januar>* H). after Uung exposed to the cold on detrk for two hours, hewi 
denly seized with nau.'^ea and vomiting. He had no recollectioii of a cM 
retinnl to his bunk, feeling very dizzy and f«n'eri.sh, and in a few boon I 
distresse^l with a severe pain in tlu^ left intra mammary region, ^rhich wsw 
aggravate<l by a dry, hacking cou^h. The next morning he was removeil 
hospital in the ambulance. His temperature was then 89* C. , pulse 1 1^<. ha 
bounding; his cheeks were red and Hushe<l. facies showed expression of a 
and appn>hension ; tongue wliire ami furred: c-ough was pronounced and s] 
abun(hmt, frothy, and tingrMl Avith red. < )n penmssion dullness was eliciw 
left lower lobe, and hyiH-rresonanc*^ over right lung and remainder of left 
cidtation revc-aled immerous iiii»> nlles in lower left l(d)e, >vith exaggetau 
p^'»>longed r«'S])iratory somids ovi'r balame of both lungs. Examination 
sputum showed Fraenkel's ])neniiKM-<»ccus, numerous streptococci and Bta 
C'K'ci, together Avith structural eli-nn'nts. Not much chang^e in the patient 
dition was noted until tlie morning of the 22d, when signs of oedema of tbfl 
were manifest: respiration becani«' rapi«l and lal.>ored. while the pulse ccRi 
at the sam(} ratt* ( UH), but weaker. ( )n the (^vening of the 23tl he was hk 
c. c. of blfMid being withdrawn, aft<-r which he .showed some apparent im 
men t until JJ a. ni. of tlie 21th, when jiuNe and respiration rapidlv failed, 
came cya7ios«d, and at ."i a. m. died. 

yrrr(t})S!f (tinnfji-sir lumrx (iffrr thtifh). — Bmlv that of a 'well>uounsh«d 
about 1)0 y»^ars of ag*-. Kii^tn- mortis pronounciMl. Head rather small. '■ 
dilated. Calvarinm n'inov»d: <hira mater ajjparently normal, no evilei 
sj-rous effusion: sinuses disii-nded. lii'aiTi normal: weight 1.29<) i^rauis. 1 
oiM.'ned. Pericarrliuni n«)t thiclo'ned. containi'd 1.*) c. c. of bhxnly fluid: an 
of roughened areas mi pai'ietal surfaci*. The .sinfact-of the rij^ht ventricle si 
numerous sjMits <^i ecchymosis. In bntli caviti«'s of the heart were larff 
firm, ant^'-ni<»rleni clots. «'iitangli*d in the chorda* tendiiue and involvi] 
auriculo v«'ntricular valves. Anrtic and pulmonary valves 'were competfl 
few roughened spots of endart«'rilis in aorta. The left luuK "was adherent I 
and to pericardium, the lower lobe s«>lidi(i<'d and in a condition of red hei 
tion; the upper IoIm? cr<*pitant. th«»ugh much congested, with extenaiveors 
fibrinous effusion post«riorly: weii^lir. Uxo grains. The right luns WBB boi 
walls by old adhesions o\ er entire snrfatf. ex«('])t a .^mall i^ptice posteriorly. 
lungs wer«' o'dematous and showed v«ry mark<Ml anthracosiar^ The bw 
glands enlargtid on both sides. Liver normal: weight 1.1^90 i^^rams. GNAt 



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148 MA RINK-HOSPITAL SERVICK. 

orj<aii>: Kiihu^vs. left, \v«M;^ht ;r»0 grains, is somewhat con j^osttMl , but 
noniial. Rij^lit, \v«-i;<lit :i<»() ^nims, (ronj^csted. SpU^on. \veiji:ht 8o(»irraiii 
••nlar^'Hl. color iiornial. Bla(l<l«*r normal. Suprart^mil (■ax>sules norm 
W<-ij^ht 4 Knims; right. w«'i«j:ht -kri jrrams. Other viscera normal. 1 
examined. 

Pmnimnn'tt, lolxir. 

J. Jf.; a;;e. 50y<^ar.s; nativity, Nt*w York; admitted to the ITnitorl Stat< 
Jlosjiital, Staph-'ton. Statin Island, August 1<>, HMM); died An^nst Ifi, 19il 

///n/o/-//. -Patient entennl hospital in r.vfmnis. ImiK>8sible to j?ot hisi 
him. 

I^htfsirtil r.niiniiuifinn. — (rfMicral aj)i)oaran(re that of an alcoholic: pert 
(rlH'st reveals absolute Hatn<^ss of entire right lung from »]x^x to ba.*^; rig 
rlh'st eontra<'t<"d and only transmitt«Ml sounds heard. Left liiii*^: Pen/ns 
liyiMjr-resonant: auscultation reveals sononms and snlKTepitant rAK'S 
The wiunds of the h<^art oblit(;ratt.'d by the aggnivaled broath soiin<l.s oi 
lung; J" ixrx beat displaced d<>\vnward. Skin: There is a red enii>tion th 
trilMit»'d upon tliM arms, shoulders, and chest, and less so on tlio abdoi 
lated, ma(Milar spots abmt the sizi* of a pin head and do not fc^nn patxie; 
defined Lodges, <lisiippear on pressure and (piickly regain their color. 
glands not enlarged: no s<'ar on penis. 

Si»utum examination: Tliick, fr(>thy. tenacious in character ami the 
lirick dust, or i»rune jnicj*; di])l'MM»cciof ]>neumonia found in larjLce cpianti 
other bacteria. Treatment : Stimulation by nitrt)glycerine. digitalinf.an< 
Died suddenlv. 

AVcroy>.v// {r'nflitrv)i huurs nffrr ihafh). — I.5ody,male, ai)i)arently well iv 
alxMit ■) f(M't (> inches in heiglit, weight 140 pounds. Rigor mortis 
lIyiM)st.asis lu\v(»r ]»art of l>ody marked. SubcutaneoiLS fat abnndaul 
lung: liound down by nnmer«»as adhesions t > c kst^il w^all and diaphragm. 1 
an«l middle lob-s in a sjatt^ of beLrinning resoluti(m and gniy liei>atizati« 
lolw engorged; cut surface shows frothy exudate. Weight of luuf^, 2.H 
Left lung: Apex slightly adherent to costal wall, old iidhesious t'xteiid 
ajM'X to diaphragm pnst^'riorly, lung beings nailer than the average, "weij 
grams, 1o1k*s iM'ing fioiind by adhesions indicating a prexnou.s pneumonia 
K»^nn)ve<I and o]iened; sii)p]»ed in diastole, most marked on left aide: a 
di'posits on twcuspid valves; nther valves normal. "Weight 350 grar 
])hragm: In n:»rmal ]>ositi.»n. Liv<r, normal, weighs 1,9.*)0 grams. Gall 
distended with hile. contained om- calculus about the size of a robin's e" 
ent to du«Mlenum. Right kidney in normal position, weight 200 grams, 
mal in character. Lett kidney normal, weight '^."iO gnims. Splet^n «Tf 
gi'sted and )>ound di»wn by adhesions. Intestines greatly distended i 
IJrain normal. 

T. 
G 

I*iirniii(iiii(i. 

I 

1*. K. : age, ill): native of Kngland; admitted t«» the marine ward of tht 
lIos])iial, iMiiladel])hia. Pa., July :;o, I'.mm). died July :n, 1«HH». 

Ilishn-ij. \\:\\\ lieeti ill iive days with fever, pam in i.'hest, and eoU'H 
]>hysical e\aniinatiu:i the entire vv^\\\ bin^ was Innnd to Ln.» fonssni^^l^t 
left lung pre-fiMed eviileiue uf an iicute ^ n't Muhiti^. Tht» luilse WSiS T 
Weak. an«l tiie L^eiieral j-<»ndition nf th-- ^-atienr was very l»ad. Despite 
treatment he i;ii w >teadilv w^vm- and <li'<l withm twenty-four h»»ui's of 1; 
sion t') tile hi»-'[»:Ml. 

,V' r-y «/!>// {I'll liftiii s ill f' r li'nfh .- 'I'he hi.ily is that of :i widl <levelo 
nonn-xln'il adult wlnie nial<-. Iii?i«'i' in •: t is js pr<'>enT lo a slig:ht deirr«N 
isnoudem,!. Tlii'n' ati- ;Mlln■>l•'l!•^ ;'.t ', lit' lia»* nf lioth lu'.^gs. The ri'd 
thnmt^htnit in a duditi'in <•{ ui'a\ hejiat izi!ti<»n. the cut ^'H'faees i»xndix] 
ish punilenT tiuiil. Tlie litt lung i'^ cnn-i'-ied. tlie walls t»f th»» brti 
intlamedand -catti-ied t lir«nmh'>nt th-- lung: th'-n* are >mall areas itfeon**- 
Tile lif.irt and j'erit anbinn ;■!■•• n«>nnal 'I'lh- inte«.tinal trai'tis normal" 
ne\ s ari' i:i a ci 'iiditi" 'U i>t" .mmU" |'avin"!:;niat' ■'.'i intlammatiou. The ri*'' 
wemli*> It'i") -ram> ilii' ii-!t I '» I Lrr;ini> The ri-t of the g*'nito-iirinari 
normal. Th*- ^plt . n is -^ligiitl.N iii> n .»-i«l in m/.«-, and weighs :.»4t> vrni 
Ijuncri-a-* i** imrmal. Tlie l>rain and >pinai t «rd were nut exauiintHl. 

] 



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150 MABIXE-HO^PITAL S£BVIC£. 

iiuinotliarf'ly l»ontfath Hk' capsnl*^ 'wl-.ifli »1iip> nnt preseiir a \ravy appoafaw* 
an» small nn-as in wliit-h tln.-r*' iirr- nilltM-Tiniis nf «*onn*^ctive tissiif tvlls ami '.^■ 
plnK"yt<'s. Ill jsdiiie of t1i«'h- aivii-^ tIriT*' i- «iln'a<ly ov»'rj^ro\nli ttt thf oniij^fH^ 
tissiu' HImts. with n-.sultiiijr atmjiliy nt* tlit- pan-nchyma. Thf Mal]n;;liiaii )>i'i:- 
vary f?r«atly in sizt.\ Th»-ir Kl«'ia»'rnli aiv sliu'litly slirnukeu ami their {-Apri- 
arr* sli;<htly thi(rken«Ml. Tin* iKireiirhyiiia i> s« »iui'what granular aii<l clonily.oty 
wise normal. Livt-r: This (>r;^au shn\\> sume >ta^aiatii)ii of blixxl in theceiivr . 
its lol Mill's. The crlls. esiH'cially thi.^i* surrMundinjr the intralobular Vfins..;. 
heavily hmch'd witli fin** }»ro\\Ti ^oranular pi^nncnt. There id \-isible als*') a-ti" 
oncy to l\ani>h<K.'ytic a^^jcn -gat inn around thi* periphery of the lobnU's. ThelC 
(Incts an* nonncil. LunLfs: Tlic* M*pta art* normal and shovr lU) h\^»en^'llli:l. T 
alvooli an» filled with d«-s4nMmated fpitlnliniii and lyniphocyti's/alaio af?v]- 
inori>honiiclears. In some thi-re i> evidence i»i' i-oajLi!^lati.*d Huid. 

M.E.L 
M. J. V 
J. M. <i 

f'hmm'r Hrujlif's tli.snis,-, iottfir jhh mnntiia, itn(l rht'ntmitixitt, 

M. S. : age. 47: nativity, (xormany: admittf-d to Unite<l St4it«)s Marine H<B«]tiu 
Stapk'ton. Htat<-n Island.* July ."i, iwiMi: died August 11. 1$MK). 

Faiitilji h istorif. — Mother died < 'f heni< a-rhage i »t" the lungs wliile yi)nug. Falit* 
died of old age. 

J*n'ri(}ns htstor/f. — Usual diseases of childlKNMl. At Alexandria, Eyvp*-*^'"* 
twenty years ago, had ty])hoid fever. Had rhoumatisiu in Australia ntxr 
twenty years ago, and has l»e<'n affected with it off and on ever sinc^e. ^mir 
and drinks. 

Pi'cHciit hisittnj. — Ten days ago hegan to have dyspna^a, con^jch, mnco-puinlrt^ 
exiK.'ct-oration, jwiin in ehest. and (i'<lema of feet. lias acute articular rhenniatio 
affec^ting at present tho right f<M)t and right shoulder. 




taining about (>.4 ]M'r cj-nt of albumen, pus (•♦'lis. and numerous bacteria. Xtz.- 
is voi«ied with dififirulty. and on examination a deep i)erineal stricture is fi^ntl 

Trcatiutuf. — Confined to ImmI. Milk di«'r. Preserii>tion of ammo, clilorii; 
ammo. carb.. sui. 7..") gm.: mist, glyoyrrbiza' (•nmi)..ad 1()0. M., si^.. 6 c. c. t^^^" 
4 hours, (five also sodii sfdicylatis, 1 gin., cj. '^ hours. Apply to inflameil j*^'- 
e<pial part** of ol. gaultheria-. spts. vini r(M-t.. and lin. chloniformis on lint ct»v»<^: 
by oiled silk. 

.////// iJ.— No liyspno-a. Right (Dm )W painfully swollen and red. Other yc> 
iM'tt+'r. Ap]»ly liniment to el how. (live inf. digitalis, ITk". c, t. i. d. Bowelsic* 
tive. Give mag. snl] ill., l") g. (*ouglis <-onsiderably: apiwtit^ IJOor. 

.//</// 7.7. — No marked im])rivem«'nt. Cough medicine 8topi)ed. Orderwl e^^ 
l^irts of wine of ipi-cac and wat«r as spray, to be iidialcMl. Teeth in very pooroi".- 
dition. r4ums .swollen and ul*'craicd. Foul iwlor from month. To use nu*^ 
wash of t*.") jM-r cent solution «u!liymoI. 

»/"/// //.Cough and «-x]»ecti>ratiou le>s. A]>])etite p<mit. Vomited thisa.^ 
Passes »lH)ut 1 .*.'«'«» c. c. of higldy alhuminons urine daily. Condition of g ntii* d^ 
imjn'oved. ( 'hli>ralc dT jMitash and tr. myrrli swabbed over gums. All inUii* 
medication sti.i]»pfd. 

Jntif ::.'f. Condiiion much wi)V>o. l)ys])iMea marked for past 24 hours. UmWi 
to urinate f.»r i)ast :»day.«*. Ibul ti>)»i' < atln-teriziMl with silver catheter. Strictsr 
alniiK^toccbuli'sun'tlira. I *r« '-script ion: Stryrli. -;ul]>h..<).0-l; craffein rit. . 4; tx. 8SP' 
]>hanthus, lo; aquje. ad HM) r. <-. ;m.. >ig.: .") c. c.. t. i. d. Sulwtitute for pl«f 
mouth wash. sol. jrrniangaiiate of jintash. l-.)iH)(). 

,//»/// .''.'.- Milk ]iaiici"eatiniz«d.liut vniiiitiiig ci»n1inuch. Rhoniuatisni continw 
butismucliK'tier. Submaxillary glan«N swoll«'i: and tender. Catheterized da$ 
^lustard ]»lasti-r over epiga>t!inm. :iin| c<'cain«' io I'elieve v«»Tnitiiig. 

./f//// .sv/.— Klhumatism in lelt wrist ami ankl«' wi»rse since last ni|fht. MoBti 
alK»ut thesam*'. Can retain milk firetty well. St<ip permanganate mouth Wtfl 
I'w as moutli wash acid salicylic. !: tinct. cincliona co.. TM): nquie. ad. 200. 31 
filter. Paint wrist and knee with iodine. 

Antinst ;. l)ysj»no-a distressing. Had a chill this moniing. TempefrntttW^ 
Vomited Headache. Now urinates voluntarily. Kowels active. Friction flOOil 
over right side of chest. Stop pre.'^eut medication. Feed iM»r rectum wiftb|lii 
gest«il I'immI. 



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152 MAKIN'K-IfnsPITAL SKRVICK- 

t*-T J'] i ni#* f HiCfile : conorftinns a roii nd mitral aii«l aortic valv€*s. Weifrbt . "iT"* irraff 
A!"l'iiijwi: (.'aviiy rontaiinMl l.-i?.', c. r. of s»^r.»iis t1ni<l; onientniii thin ami > -iar 
wirli }ii} int. Liver: Dark amy in r«»lur. *■ h(>biiail«*«i ' on siirlave. lianl andil-'j-l 
t'^ tlj«f tniirli. witli iiiarlM.-il r«-si-:taii(v to ruttiii;^; rij^lit li»}>e very ri.)iuiilt^ ic! 
]iroiiiin»:rii . Woitrlit. I. «»**'» ;; rains. Gall l»lad<ler j<reatly dist^uded rr 
iijt»-ii-i«'ly l,];ick fliiijl. Paiicn-;is normal. Spli-en: Light K^J^y in color: wtic: 
1 10 ^raiii-i. Ki<liieys: Ri;;lit l<i<hu-y hard .and dense: several hanl paicILr 
fm\ii*-u('*-A on surfat-f*. (.'urti^-al snh>tanc<* dark-rf^ colnr, c*out*iiniiisf a nnmVr ; 
ravitii-s aliiut 1 rm. in dianii.'t«'r. and containinjc a clt^ar serous fluid: meilciliT 
ix>rtinn wa-i of a dirty y<'lli>w <i>lnr. W(.-ij^lit, IIM) grains. Left 1ddn«*y i^aEQr : 
ajiM.'aranrMf as ri;<lit. Wei.irlit, 'Jim) trranis. L«.»ft suprarenal ca|»snlp fini: 
a^linrrent. T'r«.'t<*rs nnnnal. Bladd»'r dist'-ndod with urine. 

B.D.? 
J, G, 

('hr*niit' hrniivhitls. u'lfh tthscfss itf hiug. 

E.G.: whit^': au'^-..")!): nativity. Canada; admitted to the United States JUri:- 
Ho-pital. iifdtimor--. Md.. .Tiiih- \.'i. P.hh): died July l«». UM)0. r>iafai«>$is. rhT.t; 
hronr-hitis. 

/■>///# //// }i iaUn-i. — Nf'^^ativ*'. 

J'l'i'soinil hUtnrn. — Mivlj-rati* drinkor: has had mumps, scarlet fever, diplitlhrj 
<rhirk<-n jm^x. and livf-r troiiM**. Has had a con^h fj»r the last sixteen years. H» 
lost fl«*sh rapidly in tho last Av«Mrk pn-vi(ms t > entrance to hospital: says he lias k 
HiM-lls of weakness \vlii(;li conu? on him suddenly and leave nim almost Leljue* 
Ojiidition of x>atient on admission not ^ood: howels loose: persistent jMiroxT^ 
<*ou>^h; f'XiM.'ctoration fibrinous, and oxiM-Ued ^^ith difficulty. On inspecfl'i 
emaciation was mark**d: auscultation revealed larfijfe moist rules. TempewiOf 
wlnm admitted '•\\)A\ . Mic-rost'opical cxanii nation of sputum revealed the pre^ec^ 
of strept«><.tr»cei. staphyhn-fx-ci, and diphx-rK-ci in large numbers. Patient gradtbEj 
gr<-w wcak^T. sulfering a great deal from violent paroxysms of CH^nirhinff ail 
dii'd July 10 at r,. 10 a. m. 

Strrttpsji iiiinf inmrs nffrr di'itili). — Post-mortem lividity present in depends 

i>arts: rigor nK)rtis w«ll markrd; gen«Tal nourishment poor; pupils invgolc 
leart weightMl Wlh grams ai id was normal. Left lung adherent anteriorlv aic 
jK^steriorly; pat<rli<*s (»f eonsolidation in apt,'x: small abscess at base; air cellsfilk< 
with iMirulent matr»r: w<ij;lu'd soo grams. Right lung adherent at apej: entin 
organ showed hyi)ostati<* eomcestion, with areas of consoli<lation at base; wei^ 
H<M) grams. Liv<-r w^'iglicd 1 .()i »s grams and was normal. Left kidney ^veigheoK 
grams and show«'d ('vidr'ncrs of 8"ptic «'niboli: right kidney weifajhetl 170 gill* 
and was normal. Spl«*<'n wigh«*d 'JO.*, grams and was normal. CalToziia 
removi'd: brain and menibranis normal: weight of bmin, I.IJT*) if^rams. 

k. W. G. 

G, P. 

Artifr jth Hn'sif: fhroiiir (itnt'nu'n. 

T. W.; ago, 51 years: nativity, N<'wYork: admitted tothoUnitfHl States Httiv 
iro?*pital. New York (Staphton*. X. Y., Juno T. 1900, and died Jtilv 9 1901 
Chief cromplaint, malaria. 

Pnrions fi istnrt/. —Ihis had chills and fever several times: had chancres ODOt 
Pn'sent illness lM*gan four w«'eksago Avitli a chill, followed by f ever and headadv- 

I'Injsicnl c.i'iinthititinii.—Wv\\ nourished and developed: face and body is um- 
dice<l; conjunctiva' are pale: nnkles o'dematous: heart, lungs, liver, and spka 
are negative. 

Trruttmiii. — Patient was jnit on ;j pill of iron, arsenic et Ntrj'chnia, t. i. d. 

Jifii/ fj. — Hlood e.xamin.ition shows absence of leuct.K'ytosis, absence of plasnk'' 
dium malaria', and ab.-ence of Tiuch-ated red bl«)od coi-puscles. 

J "if/ /.— Patient <'an walk to <loset. Imt shows marked dy.sjmcea. There is dnll* 
ness at base of right lung. 

Jul If ^.- Pati»'nt is confintMl to bed with shortness i)f brt?ath. 

Jniij U.-- Death. 

\irrnfisff {hrriilfi-j'ttnr lnuirs nftir dififh). — Body that of male, 'white, Itffi 
alK)ut ."»o years. Slight o'deina of ankles and scrotum: marked pallor of ]ips,cot- 
junctiva'. ami face: fat well retained: no jaundice iH»rceptible. CalvarnV 
r«*mov»'d: sinuses, vessels, brain, bones. an<l membranes negative. AnterifV 
me<liaHtinum negativi?. Remains of thymus gland negative. . Pericardium ov- 
tiiins alKiut 75 c. c. of straw-colored fluid. Pericardium afjiMirently noimiL 
Heart: Weight. 100 grams; viilves apiwirently normal; *'clucKen-fBt" dots ii 



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risluMl julult Avhitr' iniik*: wei^lit. .V) kilo^ims. Ri^f )i* inor tid well vas^ 



154 SCABiyE-HCtPITAL S£BVICE. 

T'.'EZH'.UE: • »F Ll'XGS. 

J . Y . : ag»? . 4 J y - ^ r - : . . - : ■ -r y rli. _■'. .-^u'.: Wit> a^lmi 1 1^ t^ j the Uiiite«i S» 
Marine Ilosintiil. \- t. : >.^'. r riL .^ . • \i!.. April 4. and <lied April 17. li*'I. 

///.s/r;/-//.— M'.::.-r 'i-.i'i ..-,'?--. :.--•.::; J. :iv-n. Patient liacl yelKkw ferert&r 
years af^o, ail" 1 L.i* :..i; i....* -.rl . lir }-;vi a o.»uph, extreme dVspncea. and ec 
8W(»aT.s for <► Vera y-itr. ;»:-::.. 1 *. *: a''-::: 4'» pt»iincLs in 'weig^ht. He had a 
pain in rht -^t Ltttrly. A^ > r!-r - ,»::! ■:■•:;'': ij-iwels c|uite loose: slept poorly: hfc;» 
larjTij^eal rMnii»lii.ati"L: i\zA wa* v-ry l.-Aiiirs^. 

Piti/si'-al *'.r<ii„inn*'-. — Ir.*> ri- :.: «Tr»ra:ly emaciated: scapnlse piomurr 
left hK-apnla move«l wirli r»-j-:ra::'i;. ri:rLr s -^ms immobilized: breathing: n^ 
alKlouiinal . and Vfr-ry laV-.in.'i. Palj ati' n: V«>-al fremitus increa^sed on bothsi 
but gr<*at«T on ritrlit ti;a:i 1- ::. < 'arlia • imi»til.s»^ felt in fifth intenpacv. .^ 
insidi* nianniiary lini". Prr."U>-:-M: AM«-ri'-rly entire riKht limg^ dnll; Irftic 
dull down to third int»r>] ;i«»-. Pi.-Tvii-irly U»th Inu^ dull down to aVflU/ 
fifth rib. Ansmlrati-Ti: O-urs*- cr- i-itant and sulxrrepitaut riiles heard orer^ 
uppt-r lolHfof th«^ If-tt jiuiL' an«l i.-xt-ndinir down to alxnit the fourth rib. l*^ 
tlui reniaindrr of tin* l<-ft 1ih!;^m- l;»ard bri>nt-liial breathing. Right Inn^Bi- 
l)ling rah's. crcintant ai:d <iiUr'-i»iraiir. h»aril <>vi.'r entire Inng. also well-^kb' 
fnction sounds. Ih-ari: Sizf* and poMTion normal; no nnirmurs; pnlst* 124K 
niinut4>. of low t«'nsion and small voIuhk*. Tuln'rcle bacUli were fom«lia- 
sputum in immense numlK*rs. Hi* was jmt on an easily digestible spe ial i>" 
was j^ivcn sedative.s for liis coULrh. tonics, and stimulants. For a f. w<Lt«l 
showrd some slight imiirovt-mnnt, then he suddenly liegan gn»wiug r»pi= 
weaker, and on April 17 difd. 

Si 
nouns 

l*ost-mortem lividity .slight. Panicuhis adiiM>sus wanty. Abdominal wtu 
normal in eolor. Omentum samtily snppli«*(i with fat. 'Pat of anterior nkC- 
iistinum also sranty. Pericardial cavity contains alM>ut 50 c. c. of straw-oM 
fluid. Heart: Wcij^fht, o>^.")j,'ranis: aortic and pnlmmary valves supp<jrt a cfitast 
ofwatiT: lieart muscl«; s Jinewliat Ilal»by, alxuit normal in color and thickan 
The aortic valves sliow a few small alln'romat ms i»at<^he8. The oth^^r valvea* 
iKtrmal. Pleura: Tlie parietal and vis<;eral layers are ailherent over entiw^ 
face i»n l>oth sides. entirely obliteratin.i<])leural ca\itie8, the adhesdons beingnc- 
tirmeron ri.Lcht .side. Left lun;,': Weif^'lit, i»so ^rams; floats in water; npperli* 
and up]>er tliird of lower entirely « -on soli da ted. the upj)er in various phiCfslxE 
in a cMidiiioTi of eua.i;:ulation ne<Tosis, and many .small caWties found in npp 
IoIh'. Tliercari" miliary tubercle's scattered ovct the entire lung and the h*^ 
]Kirt of l..\v rl »'. ■ i-i greatly contccsted and o'dematous. Right 'lung: Wti^ 
lK»i» Lrrani'-; v« i y iirnily adlnTJiit to the ch«st wall: in a condition similaT to Ir' 
but fnrth«M-ailv,»ni-ed. Livir: Weii^ht. l.T^o ^rams: Hurfiu'e smooth: cutsnif* 
slightly coup'si I'd: otln-rwise apparently noniial. Gall bliulder: IMstendedv^ 
biU': its duct patulous. Pancreas: Weij^ht, 1 l.*i grams, ammrently nor* 
SpliiTi: Wi ii:ht, "JiMi u^ranis: iis snrfa«'e shows some small dark markinKS. bit 
sn\^' :'i: cu: snrfaci'ap])ear«;>liichtly con^^csted: Ma Ipi^hian corpuscles IndLtiB' 
l.t'.. 'xi.liiiy: Wei^'iit. ! To i^rani^: surt-u-e s!n«M»th: cai)sule strijis readily; meft 
l»»v> v.ixs ,juiie distinct: nothing abnormal. ai>])ari'ntly. macroscopically.* R^ 
ki.b;, \ Wei.i;lit. 1~'«> .u'raio: in e\«ry way similar t4» its fello^r. uitestiD 
rh:\'i;. ::•■*»« I i^veaii r ]»ari of ileum is seen ih«' sliaved-lH»anl Appearance duncft 
ixv., ,c ev.Tcr;c t. \. r. t'.'ili'l in The ca'cuni Were four a8c.*arides lumbricoii 
:i\i '.i^^y.u a^t'T ' I I Tc. Ill lt'Ui;:h. Se\«-ral t'lU-rcular ulcers Were found in t 
\.v : \\\^^^\'^w^ ^^■.•^.Ja. ii >liL;htl\ .miu.-^Ted: oTln-rwist* normal. Bladder OB 
!•:-. .'\ , .T/v.i. :■ ■ w.ris ii.'ii:'.;;'. liraiii: W«'iu'ht: 1 .l-"*'^ gniuis: appean UQ 

' V ri!'*.-,.'.i um a] 'I'car-s :iuiti» normal. Heart: The in« 

* ..' i '.. '.c :iv«- ..'1 ^^' 11 -: li^-'ti; t .■• !■ -niriTudinal striations are qn 
, V.--. v!'.Mv.. -...aT:::. t b.'^c, n. The-e i> a deposit of fine ln«> 

.. ■ ■ ;»; JM I :•..' V- :•- c • ei".--. I h.^ \\;i-.'.s . -r \\w coivnarv arterics apv 

^' ■ '^ ■ ■■-d r\ •■.•.» 1: ■- :'.:i K. vci. p;;v:'. ul;-.r:y its libix>^laBtiC8SS 

■ ■ i ^^••■- • ^^ '•■■■■ . !-.Nc n^./.- iv'.N s ...TTcrcd throughout itstU 

■ ^ ■ -■■./:. N x;.-- .--■1^;' -'d c.lU.;.^:.i ::::vr.:.- .;r;uiD)-- matter. Hon I 
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.Ml liilii r '.M •■ ii«ii iii;il. l|i:i!l inii>«l<-: Snim-what fra.irmi'iitary. C**llaaml 
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158 mar:xe-e--p:tal -ervii-e. 

tiiMUH iiuiiiiiwal. R»->;r^r.r: :.- ---r" ^.-.V. - ■' I r»' ■.•1: j-il^'- r-.ij'id aci f^- 
CyuTiosis ami ilyHpiM-a ]r-:' ■::.■: " ■. -- *: T-:-.---r»-':ir*- 'iii< n. m 
HiH'iiiiio worn*; aiirl t]wt\ at ". ■ • ' : . : : 

.V< rn >y ;n// ( / irri ro hnn, s 't-' • • * . _ p. . ". ■ ■ : .* i^;» ".. - . .fci.T»;ir*- liT Iv 4 ■"» y.;i> 
Ri^or mortis w«-ll «l»*vel"i"- 1: -'.:_■':.: v -• -r. r -"jjtI'..*:: iiis: \-i:iii<-iar».-<l: iiiv^.i 
ilrvi'lo])!) lent pot jr: no mark- f v: ".-:. - -.-..- -'.:.•::: ••rui'-- '»zi l»-ft ann: :■" 
dilat^Ml: Hniall R:ar <»n l»^ft k!;-- : r - rl r :..-•:: i-*::.-:.: i.< miiil: th>^a^.*!v^j 
not fouial: iHfricanlinm Mn -•':;. l:'.»l".:.j. ;i:: 1 o T-.a:!-.-? c-I-ar s^miii. H-- 
Lrft vcntrii-l*' c:«jntrarr»-'l: ■nSir. - :* ; :■ ". ■:. -:v.;: }-'rh aiiricl»-i. rl-'h" ' 
triclr, and Vfnji* cava* C"ntti:i; f.'vA '■ '. ■ \ ix\ : - :z S. ■'•••1 }•'•» -i: puliii'iiur. ■ 
Ht'Ls ami aorta contain an^^-i.-p.-r*-:.: ■'. ". *...i'Ii.* : !:i Ir-fr vr'Tirri^-l^-. > ilj-^. 
ailhcTcnt to it: aortic orirtt;«M"nij.-'-:.* * '.. :r -■»»-: • t-*r: viilv^^s ii »nua': ii' 
on fico admits two fniK'-rs fr-.-ly: v./, ■ — :. r:i,.i'.; trl'"Ti>i»i«l aii'l ?*.'iuihinarri" 
rtpiKirontlyall ri;Lrlit: Ci'r»nary vi.--r-S- ..>::•: my --.ir-linia 5?]io\v> ii'itfros-iihr- 
lioart wci^'lis :{J0 jrram-. L't: j'- ::• i: A Ih- <: ::- all apiiind aiH='X «»f lnii::.r:. 
its]M»stcrior surfac'*: a^niiir .',•.■. ,-. . ■: . :. .»r — r':!:i in cavity. Ri^rht jd'-nni: ^;. 
adli«'sions at ajMX and r-i -t ■•: '■;::_■: i. • :l\:\: ■• :> l'in;r "w-iLrhs x*^7o jrroiii' 
massii Hoat>: at aj» -x s^'vcral •■;<-'":::-- .• ^.-.li:. :'.;«' niVT'-ular d«'-bris f-mnl: r?" 
lun;^ c«»nKcst«'d and toward lia--.- -i '1-T;.a: ii- i-.rA i\\<\ very oxtt.-iiMvtdy iiifiitri 
with miliary tulx'n-l«*s: l>r«»ni;;»-al \:i'--^ I^il-d witii mu'-.i-iiunilt-iit exndatr: r. 
lun^ weit^hs s^() j^rains; larir^- raviry ji" ;.j.*-.\: r->r nf lum^ similar t») If ft: iH- 
infiltrated with miliary tuh r-l'.-: hr •:: iiial u''ands enlarijctl ami tul)^^n."ni 
>i:rc;it vessels and n»*rvo trunk** -hnw n-' lt--** ilianirHs: diaphra.Lou iionual: ••a. 
tnm contains some cnlar^^f-d .i,dan«l>: m'-enr»-r:i; ^rlamls enlari^otl ami tuK.-n-ni 
Sphi»n: Normal positiini: w»-iLihs Uo jT.iin-; lias srar i«n external surfii»v r. 
exterior l)order: sjileiiic pnli» -^huw-* nn ir :•'••*- l''<i'»ns: suiirar«:»nal j^lands l-'Ie 
Left kidney: Pnsition. siz". and (■•»n>:i«-riiiivn'«nnal: capsule ii<ina«lherent: wrij 
ISO ^rams: markin;^s fairly d^stiu'i: lurr x y«'lliAvish. Right kidney: W'-i: 
H5n ^rams; otherwise j^anip as ] ft: nrot'-r- i; Trnial. Bladder: Mncons'iu-mJ'T. 
sliows catarrhal inHamniatinii. suha"Ut»': ha< sliirlit hydnx'el.- of ri'^'ht m 
va^nalis: lar;^t' and small int«-^tini*^: slmw no tuln-rcles f>r ulcerations: iiATtV 
normal. Liver: Wii^^ht . •?,:{*<i» irrams: advanc»'d latty changres present. Btj 
Skull (rap ojK'm'd and hrain examined. Imt nothinpr of interest fonnd 

J. MS 
P. H. I 

'fiiln-i-ffi- uf 1 1I inj. 

M. IJ. C: a;^«-. -: nativity. New York: admilte«l t«» the Uiiitt^l SStatt's M;.: 
llnspital. l-'tirt Stanton, \. M<'X.. !)ecemlK'r 7. llHiu; died March :2*J, 1*.H)1. 

/'/■i /■/••. v.s itisfiu'f/ (riimh ii.t il I'l'nm rJiiii'-iif Unt* t< ttf tin' lit-'f/it'tfi tttfirtl' iitf 

iinnittiit St. l.unis.MiK). — Admit tid to tin- Unit«'d States Marine Hospital. St. L^ 
Mn.. Nnvi-mljei ;;o, I'.MHK Family lii-iory nej^ativr'. Personal historv of lUt^•^ 
fhiiki n p«»\.aiid malaria (ISDU). l*ns -lit sickness began abciiit two veai^s 
tl'n'i- nmntlis a;ro wiih e(»M. Has had cnngh evei" sin«'e and has feverinar 
nix'ij*.. Had fmir ni;;ht s\v»'ats ahmit a m"'nth a.iro. ('^tnsiderable exi)ei.'tunn 
l)>Hpini'a on exertion, emaciation, lust \'~i ]n»unds. Physical examination shi^^ 
tiipn-ssiMns almvr and Ixhiw clavirlrs. dullness over whole ri«.fht lunv. incrw 
\iM-;iJ irrmitiis in sann-. with int reas^d hr<'a?h s'funds and voc^il resonance. I 
Innt; an])ari'nlly noi'nial. Si>nlnm <'.»iitains tuhercle baeilli. Croneral cfliit 
itM|i?-i>\ I'd nnili'i" t ?'«'atm«'r)!. 'rran"-fiTr:'i| to ^^^Tt Stanton Dec<-»iuber 8. IIHNK 

«'. >ndui..n a -> n<»i(-(| nn airi\al :»! l''«»i't Stanton was .js ftdlows: GiuaciatiOD.! 
1. al I •.«•'!. nail';, anil i:mri'>: inrii :i>;ii| >..«al fri-mitus on rijL^ht Hide dallDtf 
n;-.lit hiti: . 1 \i cpt niiildN- l"h«- ariti'ri< 'ii\ . ilimini^lird resonance in left MMI^ 
h.i'»>. i;i'.::i Inn:: li:id i raiivlin - i.di-^all n\i>r.witli hroncdiial- hreatlunirfllll 
i-'iiloi|ii\ iti a]»'\ ami -mIm-Ijix iciiliir n'-rion. and iliniinished l>roaf*~* — ■■**■ 
Lili Imm:l vlh'W' •! a tVw ral--^ in ap-'x and has-'. Heart artion weak 
til.' rinli. Ii dia o i,;ii tiiHi an<i a'lMliin' r. -artion. Sputum shoT— ■ ' 
h.u \\\\ ri.i-. w.i-. a '..Tion-* I a. M- on arrival, and though slight in 
iHiMMi-il 1! ^^ a- i'Ji1\ tfinpi '?".iry . an! thi' case propnnp ■■ 

lapidlv 

\ s '. • A n I: .N 1 It., ... .i//i I . In^pi'i't ion '' 

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i.tiiii-il iii'.o ■■•I ( iiU ]« u1oii>< -land's. Heart 
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156 MARINK-H08PITAL SERVICE. 

/iright's dismsr—f 'ttrnnir nephritis. 

.7. D.; {i^e. •»•"> yojirs: iiHtivity, Pi'inu^ylvuuiji: was a(liuitt<'<l to tb»* ITiiiteil Stat« 
Miiriuc* PI<»spital, ]H)rt of San Francisco. Cii\., Fchruarv i:> and (lie<l Fel)niarj' "i^. 
1JM)1. 

Historif. —Family: Father (lca<l : canso. tulMjivul* )-i8. Mother deiul : caiise. tnher- 
ciilosis. Four hr. »thcrs died in infancy: cans,? nnknr»wn. Pationt had pneu- 
monia twelve years a^o: liad inHammation i\i Imrsa i)atonio oijifht vfiiirs ajfi?: hatl 
gonorrhea fcmr times: di^nied syphilis. Halnts: Patient smoked to exc**-s8 anil 
used alcohol moderately. Patient had been tronhled with contfh an«.l exixH-torj- 
tion f or ahout four nmnths; had lost very little in wei^^ht, and his ai»i>etite was 
TKX)r. Ho had ]H»on dyspiui'ic on exertion for alwrnt two years. Aliont a wev'k 
l)eforo entoriiiff the hosiiital ])atient had several chills, followed by swoatin^. 
Tho congh and exiH^ctoration In^came ani^niiented and (^ansed great pain in his 
left hmg. Tho expectoration was purulent and of a very disagrt*eable olnr. 
Patient ha<l l)oon deaf in his left (»ar for fifteen years, and lately ha<l become 
hard cjf hearing in his nj^ht ear. Patient's lK)wel8 were very hvise: he slept 
l)Oorly, and was v<'ry weak. 

Phifsimi r.ntun'niftuni. — Palpation: Increased fremitus over riglit ajx^x. Pe^ 
ciission: A dull note over apex (»f light lung. Tympanitic note over middle lobe 
of left lung. AuscultatioTi: Bronchial breathing and numerous rales. Fnun 
time patient entered he had profuse night sweats, vomit^^d mtnlicines. and rapidly 
gn*w weaker. 

Treat mm f. — Bismuth ^ubnitrateand Dover's powders to<"ontrol lx)wel.s: strych- 
nine an<l whisky as a tonic: atropine for night sweats, and co<leiue inixtnre fiff 
c<mgh. \vith abundant, easily digestible nourishment. His temperatnre varieil 
l>etween oO.'J C. and '^x.x C. The tulxrcle biicillus. though sought for, was not 
f(mnd. 

yrrropsi/ {r'nfht hours afit r (hath). — B^nly that of an adult wliite male, mnch 
emaciahnl, alxmt 1 .(m meters in height, and weighing alxmt 00 kilograms. Mnscnlar 
dev«*lopment jwrnr. Upon the right shin there is a smooth, wliit« scar 2 by 5 cm. 
in area. Ri;^'or mortis an<l ]M>st-mortem lividity fairly well marked. Brain: 
Weight, Kilograms: nonual. Skeletal muscles along incision anteriorly appear 
uonnal. Anterior meiliastinum normal. J Vricardium normal. Heart: 'Weight. 
IJ0*2 grams: normal. Right Inng: Weight, si o grams: is completely consolidated 
at its apex, and the upjier and middle lolx'S are riddled \\\t\\ cavities and smaller 
al>scesses. Left lung: Wei;;ht, I'M grams: is not nearly so solid and is mnch more 
(i^lemat^ms. Liver: Wtjight, 1 .<»(Ji) grams: about normal in size. Tlio right lolw 
is S(»ft and rather friable. The lett lobe is rather firm, due to abnormal ftbnms 
tissue. Left kidnt-y: Weight, 'in.") grams: surface mottled: l.irge, white kidney. 
Right kidney: C'a]>sule sonufwhat adherent, otherwise similar in all respects to 
left. Si)leen: Weight. IL*").") grams: eidarged and shows evidence of old porisj^leni- 
tis: somewhat congeste<l. The other viscera an» ai)par<'ntlv normal. 

A. M. M. 
C. W. V. 
J. M. G. 

Mt'orosf'iipirdf report. — Pericardium: Atrophy of the subperic^irdial areolar tii»- 
sue: otherwi.se normal. Heart muscle: Somewhat fragmentary. Cells and nuclei 
stain w«'ll. (Voss striati<»ns discernible. ( 'oronary arteries normal. There in a 
d<'])osit of fiiie browTi graimlar ])iL;meiit in the cells, indicative of brown atrophy. 
Pleura: This is ci»nsid<'rably thickened and infiltrated \\ith connwtivotissne cells, 
it contains tubercle tissuj* throu^rhout its substance. Its surfiuH» shows an 
immense dfjr-sit of ill Tin. interspersi'd through which are granular material. 
epitln'lial celK. ;nid lyniplio<-ytes Lnng: Alni(»st entire S'vtion is consolidated. 
Tlie v<-sicbs are tilled with epithelial cells, connective tissue, and Ijnnphocytes. 
The walls of th<' vrsieh's an.' thickened and infiltrated with epithelial cells and 
lyniphoryt**^. Tlie broiichi are grejitly thickened by new connective tissne, and 
are also iiitiltrated with eijithelioid cells and lymphocytes. Many of tne vesiclM 
contaiTilanre.pah'. fatty epith«'liale<*lls. with an occasional giant cell. Theintima 
of the blood vj'ssfls is thi<k<'ned and they an* all distended with blood. Coal 
jjigment is drpositi'd \n the interstitial tiv^ue throughout the section. At varioiw 
places are seen small ab>ii»sses tilh'd with lyniph<»cytes. degenerat«l epitbelinm. 
pus c<'lls. and nneh'ar d«'-bris. Liver- A]»])ears (piite nonnal. with the ezceptiOD 
of some inmneiitation of cells. Kidneys: A few of the malpighian bodies are 
somewhat shrunken and show hyaline degeneration of portions of their fflomemll. 
Some of the cells of the ('(involuted tubules are swollen find ])ale and infiltrated 
with a granular material, but for the most part these are normal. The condnctr 



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158 MARIXK-HOSPITAL 8ERVI0K. 

Mujl ::i. — B<Mame vi'ry weak during night, but resix)nde<l to fttiiiinlation; con- 
tinues uianiiic'al. Respirations very sliallow and rapid: pnlw* rapid and feeble. 
Cyanosis and dysimiea profound: cold swe:it. Tomi)eratur»^ this a. lu.. 'M\A . 
Became worse and died at lO.lJO p. m. 

yrcntj)si/ {tirrliw. hoarn after ilr(tth). — B<Mly of a inalo. apparently 45 years old. 
Rigor mortis well develoi>ed: slight posterior suggillations: emaciated; innacnLur 
development p(X)r; no marks of violence save slight bmise on left arm: pnpiLs 
dilated: small scar on left kn(»e: ant^^rior mediastinum normal; thymiiH remaiii.*i 
not found; pericardium smooth, glistening, and contains clear serum. Heart: 
Lt^ft ventricle contracte<l: right soft: oi)ened in situ: l)oth auricles, right ven- 
tricle, and venje cavie contain fluid blood and s'ift clott«'d blood; pulmonary ves- 
sels and aorta contain ante-mortem clot; small clot in left ventricle, st^mewhat 
a<^lherent to it: aorticj orifice competent to hydrostatic test: valves normal: mitral 
orifice admits two fingers freely; valves normal; tricuspid and semilunar valves 
apjMirently all right: con mary vessels jKitent: mycK-ardium shows nofn:t>ss changes: 
heart weighs 'A20 grams. Left phnira: Adhesions all around apex of lung and tJ> 
it*4 ivosterior surface: alnmt .">() c. c. of clear serum in cavity. Right jdeura: Slight 
adhesions at a^n-x and root of lung; no fluid: left lung weighs 870 grams: en 
masse floats: at ap;'X several cavities containing tuln^rcular debris founil; rest of 
lung congeste<l and toward base (edematous and also very extensively iiiflltraretl 
\Wth miliary tulH>r<'les; bronchial tulM?s filled ^^^th nmco-immleut exudate: right 
lung weighs >^^0 grams: large t-avity at ;ji>ex: rest of lung similar to loft; den*rly 
infiltrated with miliary tubercles: bronchial glands enlarged and tubercnlous: 
great vessels and nerve trunks show no gross (changes; diaphragm normal; emeu- 
tum contains somt? enlarged ghni<ls: mesenteric glands enhirge<l and tnl>ercTilotis. 
Sjdeen: Normal position: weighs 1 U) grams: has scar on external 8iirfa<.*e near 
exterior Iwrder; s])lenic pulp shows no gross l«.»si<ms: suprarenal glands normal. 
Left kidney: Position, size, and consistency nonnal; (japsule nonadherent; "weight. 
IHO grams: markings fairly distinct: cortt»x yello"Nvish. Right kidney: Weight. 
100 grams; otherwise same as 1 ft: ureters nonnal. Bladder: Mucous uiembran«> 
shows catarrhal inflammation, subacute: has slight hydnK'elo of right tnnica 
vaginalis: large an<l small intestines show no tul)ercles or ulcerations; pancreas 
normal. Liver: Weight, 5.:JS() grams: advanced fatty changes present. Brain: 
Skull cap ojwned and brain examined, ])ut nothing t)f interest found. 

J. M. K. 
P. H. B. 

TnlH'rrh: of In inf. 

M. B. C: ag«', — : nativity. New York: admitt<»d to tlw United States Marine 
Hos])ital, F<irt Stanton, N. Mex.. l)e<-eml)er 7, 11H)(>: die<l March 22, liH)l. 

J^nrinns ln!<1(n'!i {rnii(hn.:nl fnnnrh'nictil vnttH (tf l/w lurdh'dl ojjjlitH'r in com- 
mdinliitsf. Lnnis, Mtt. ) . — Admitted to the United States Marine Hospital, St. LkvoIs. 
Mo. . NovemlxT ;{0, 1 1M)(). Family hi^t« ►ry negative. Pers<»nal history of meaales. 
chickt n X)ox. and malaria (Inim)). Presi-nt sickness l)egan about two 3*earsand 
tiJH'*' months ag«) with cold. Has had congh ever since and has fever in after- 
no* ms. Had four night sweats about a moTith ago. Considenible expectoration. 
Dysjmcea on exertion, emaciation, lost, o") pmnds. Physical examination showed 
dei>r<'Ssions alwive aiid below clavirhs. dullness over whole right lung, increased 
vocal fremitus in same, with increased breath sounds and vocal resonance. Left 
lung a] )i)arently normal. Si)ntum Cimtains tubenrle bacilli. General condition 
improvi'd under treatment. TraTisferrcd to Fort Stanton December 8, llKX). 

W. G. S. 

Condilinn as n(>ted t)n arrival at Fort Stanton was as follows: Emiiciation. typ- 
ical clh'st. nails, and guni>: in<*i<as«Ml VDcal fremitus on right side, dulliieas m 
right lun;r. ♦•xci'pt niifldle 1«»1)«' aiit«'rii'rl\ . diminished resonance in left aiiex awl 
bas4'. Kigiit hnig had i-rackliu r lah-sall over, with bnaichial breathing and jiei*- 
tijrilcHpiy in a|M'X and snbclavicuhir r<'^H(»n.and diminished breiithing in iMse. 
Left lung sliowt'd a f«'w rah-s in ajH'X and bas*-. Heart action weak. Urine gave 
tli«' Klirlieli dia/.o nse-tion and alkaliTu* r«'action. Si)utuni showed many tultenJe 
bacilli. Tliis was a serious rasenn arrival, and tlmngh slight improvement at first 
iHTurn'd it was only temporary, and the case progri.'s.sed from l>ad to worse 
ra])idly. 

.\'i nii/hsi/ \ jirr hufirs tifli r tl, nf/i ).- h]s\H'riu*u of Inidy: Emaciation: light hair 
and bhu- ••y«s. Calvariuni nnt n*inovtMl. Tliorax: Ant«Tior mediastinnm <ron- 
taincd fulart^i-d tuln-rculous ;rhinds. Heart UMrmal. Pericardium contained 
alxmt r*") (-. ('. of s<>rous fluid. Right lung almost entirely <*onsolidated and cxxn* 



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IGO MABIKE-H08PITAL 8BBVI0E. 

lolio and throngliout left lung; heart apparently nonual: urinalysis negative: 
sputum contained many tulK»rele bacilli; afternoon fever. Tliis was a very 
serious case on arrival, and a fatal tt^nnination was exjject^l sj)eeilily. Whisky 
and strychnia were administered jis indituited, and the iatt4.T iirobably prolonged 
life se^ oral days. Weakness and dyspncjea increased daily till death occnrre<l. as 
given ahovr^ 

X('t'n)}isfj {thtrtrrn intnra (tftcr dvaih). — (.'alvarium not removed. Thorax: 
Anterior mediastinum continued enlarged glands. Heart somewhat rnlarged and 
flabby. Right ventricle dilat4Ml; left normal; all valves normal. Pericanhiiin 
distended with about :2()0 c. c. of clear straw-colore<l fluid. Both Inngs consolidateil 
neiirly all ovt»r. Pleural cavities obliterate*! by ianii adhe.siom). Great vcrtssft 
and lUTve trunks normal. Diaphragm adherent to bjises of lungs. AUloint^n: 
Omentum normal. Spleen slightly enlarged and congested. Kidneys, supra- 
renal capsules, urinary bladder, organs of gen(»ration. rectum, duodeiuuii" strnnafh. 
and gall du<-ts nonnal. Liver enlarg«'d and c<)ngestod. Pan(*reas and solar j^exiu 
normal. Mensentery loaded with tubt^nrulons glands. Small and large iutestiues 
in ])l;wes showed transverse tul)ercular infiltration, (rreat vessels normal. Sum- 
mary: Dilatation c)f right veiilri(*le,iH?ricarditisAvith effusion, tuberc'ulosis of lunjCT. 
adhesion of ])leural layers, t-ougestion of liver and sjdeeu, tuberculosis of mesen- 
terv and intestines. 

C\ R. 

P. M. C. 

E. W. (colored); age.:.*.'); nativit v. Indiana; admitted t^ Tnite*! States Marine 
Hospital. F(>rt Stanton, N. Mcx., January *^>t), li)()l; died May 18, 1901. 

I^rtriaiiH liistarij {taken fnjni cliniraf nntrs t)f malical offlvt'r in coMmawl nt 
XcirOrhdus, La.). — Admitte'd tohospitiil December i.*."). 1900. Family history nej;- 
ativ<'. P.'rsonal hist«)ry, measles during childhood; gonorrhoea several timc!< in 
hist four years. Present sickne><s bfgan about three months ago with coiigh, 
whicli has been getting worse. Has cxi)e<*toration, fever, and nlglit sweats. Has 
lost H» pounds in weight. Physical examinati<m shows emaciatiim. diminished 
expansion on left side, increased fremitus on right side, impaired resoiiamre over 
right a] )ex. with pain on i)ercussion: br<»ncho- vesicular breathing at right apex. 
Tulwrcle b:irilli and <)ther forms of bacteria in sputum. Case has not improved 
in this hosjntal. 

Condition on arrival at Fort Stanton: Weakness, hoarse voice, dysi)hagia, poor 
apiH'tite, m'ght sweats. (;maciation, diminished movements of right chest, typical 
chest, nails, and gums. Vo.-al fremitus great<T on right side of chest. Dalfnetf 
in right ai>ex and uj^x^r lob** and in left base. Tenderness on right side all over 
and in h'tt base. Jii right upper lobe and ai>ex crackling rales and bronchial 
breathing. In middle lobe a large cavity anteriorly with gurgling rales: posteriorly 
bronchial breathing and crackling rales. Left lung shows harsh respiration 
throughout aTid crackling rales in l)ase. Heart ai>iMirently normal. Unnalysi? 
negative. Sputum cont4iin<'d many tubercle bacilli and varicma cocci. Blood 
examination revealed many ])lasmodia. This was a iKid case when he fint 
arri\'ed and steadily lost ground. The throat was very painful and gave much 
trouble. March ;J a severe hemorrhag<.' occurred. Tnsomnia was experienced and 
was hard to ovm-ome. Death occurred May b'J, 1901. 

ytrrojtstf (ilium t sl.rt(<ii 1nmrn(tft(i'dnth), — C'alvarium not removed. Rigor 
nu»rtis fairly well shown. Body mui-h enia(*iated. Larynx shows mneoas 
meml)rane in front swollfii and greatly eroded down to and involving the 
c-artilaunnous structure of tht; larynx. B >tli tru<.' and fals«* vocal cords entirely 
di'^t roved. Traeln-al mu(')ii- mi'iiibraiie c(»n.'.<e<ted and eroded in small piii-])oint 
areas. <K^oplia.u'eal mueM's mtiiil)rane pale: no ])oints of ulceration. Thyn»id 
gland sliow> slight bilateral i!Mlar.i;»'ment. iiot involving tlu) isthmus. Tliorai: 
Anterior media>tinu7>i eontained cTilargcd tuberculous glands. Heart: Right 
Vi'iitricl** <lilaied and <»'i .s-.-titui >]iow(m1 Miin«.i hyper tro^diy ()f the; myiX'ardinin: 
left veiiiriclf of ni»rmar si/:i'. Large ant"-morteiri clot at Ix'ginning of pnl- 
moiiary artrry. P^ndoeardium normal. All valves normal. Pericardium mod- 
erately dist<'nd«'d with el«-ar fluid: its layers .smooih. The lungs were almost 
eiitin-ly in tilt rat* 'd with c;i<e')iis mat»'rial jiTid coiit-iiined several large cavities 
in tlh-ir ajne^'s and in otiier ]):irti«»ns. Tli" pleural cavities oblit«»rated by firm 
fibrous adh«*si«>ns, necessitating the o])riiin;; nf the. lungs in situ. G-rt^t vesjielB 
and n«'T\.' trunk', norma!. I)iapiira',nii adlii-rcnt to bases of lungs and to colon. 
Ab>lonien: ()nientuni nofjiial. S»)le'n adherent, at posterior bi»r<ler. Kidneyfl 
sliowed indi>tinci ei»riieal markings ami .swelling <»f the cortex. Suprarenal 
ciipsules tihow i>ost-mortem cystic degeneration. Urinary bladder partly filled 



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162 MARINE-HOSPITAL SEBVICK. 

rhoirts. Has erosion of ri^lit vocal conl, with jmin in Rwallowine and partial 
aplioniii. Later a cavity discovered in right npixjr lolx?. Tubercle Iwicilli found 
in spntnm. LTriimlvsis negative. 

F. J. T. 

Physical condition as not e<l on arrival at F<^rt Stanton was as follows: Snspidoas 
scars on legs; typical chest and nails: limited motion of right chest: bc^arse voice: 
cough and dyspnoea: increased v(X'al fremitus in right lung: dullness in right 
lung anteriorly merging into liver dullness; posteriorly dullness in ui>i)er lobe. 
Cnw'kling rales in right lung, bronchophony al)Ove, prolonged expiration, dimin- 
ished breathing in base (left), in left lung a few cra<*kling rales, and ronghened 
breathing in apex. Hi.*art somewhat disphiced to right. Urinalysis negative. 
Sputum contained tuT)ercle bacilli. This was a serious case on arriviS. He 
improved for a time, but later on l)egan to retrograde, steadily going* down till 
the day i)revious to death, when a sinking spell was exi)erienc€d, from which he 
partially recovere<l. 

Xocntpsf/ {(ilumi srrm hours ttfter death), — Rigor mortis moderate; posterior 
lividity not seen: calvarium was not removed. Thorax: Anterior mediastinal 
glands enlarged. Layers of right pleura a<lherent all over by firm fibrous adhe- 
sions. Left X)leura adherent to chest wall , pericardium , and diapliragm. Superior 
and middle lol>es of right lung fimdy Ixmnd to chest wall and contained several 
large cavities filled \vith pus. Lower loin? and portions of upi)er lobes not entirely 
destroye<l W(»ro dt»void of air and filled with caseous material of grannlar coml<t- 
enc^. Left lung had small cavity in ai>ex. Pleura covering left apex was scarred 
in radiating lines. Entire up])iT lol)e infiltrated with caseous material. Lower 
lol)e showed miliary nodules throughout. Small amount of frothy flnid pressed 
from cut surface. Tlie smaller bronchi cr)ntained pus. Heart of soft consistence. 
Anterior (M)ronarj'' artery twisted in course. Aortic and pulmonary valves com- 
wtent. Right side of heart presented evidences of dilatation, with* hyi)ertrophj'. 
Tricuspid ()rifi(H* admitted four fingers readily. Left heart normal toroughont: 
mitral orifice admittetl thre(» fingers. Endcwarilium of entire heart smooth and 
shining. Myocardium at interventricular septum showed white lines, indicating 
fibrous change. Beginnings of a<^rta and pulmonary arteries smooth. Layers (^ 
pericardium fre<?. Tlie ix»ri(?ardial civityctmtained a small amount of straw-cd- 
ored fluid. Tongue soft and fiabby and very pale on cut section. Mucons mem- 
brane of almost entire larynx enxled. At site ol erosions were nodnlar swellings 
of large pea size. Edges of ulcerations indefinite and the Iwrdering mucons xoem- 
brane swollen. Vocal cords, true and false, entirely destroyed. Tracheal mscoiu 
membrane strongly injected and covered with purulent mucus, bnt was intact. 
Mucous membrane of cesophagus pale, but smooth. Peribronchial lymph glands 
enlarged and <leeply pigmented. Abdomen : Peritoneum smooth ana shining. 
Pelvis (H)ntained some fluid. Grt^at omentum coverwl intestines in front. Sep- 
ani})l(» fil )rous adhesit )ns between right l<.)be of liver and diaphragm. Spleen adher- 
ent at i)osterior border juid to tail of pancreas and splenic flexure of colon. 
Splenic substance softened and showed several small caseous areas, especially 
num(^r(>us just In^neath capsule. Kidneys of small size and had adherent capsoles. 
Corti<-Ml sul).stance narrowed. Glomeruli showed as glistening points. Oorticai 
markings indistinct aiid |H)ints of fibrosis present. Suprarenal capsules nonnaL 
Urinary bla<l<ler contained a small amount of urine. Organs of generation not- 
mal. Stomach normal on peritoneal surfjwM*. Liver shows the centers of the 
lobules 1o be darker than thos*.' of the periphery. Pancreas a<lherent to spleen. 
Tlirougljout ileum tul)ercular infiltrations of varjdng size, showing tendency to 
encircle the Iwjwel wall. Lyini)h channels running from these points ti) the omen- 
tal lyni])li glands were infiltrated and ntnlnlar. L\^nph glands enlargecl and 
ca.*<e(»iis. TulK'rcular f(K"i especially ninuerous near ileo-i'iecal valve. Bef^nning 
of ji])p<Midix and adjacent cjecal wall in same condition. Large intestine con- 
tained ^snI;ll^•l• tulxTcnlar foci, nion; scattered. Summary: Tuberculosis of supe- 
rior and niiddb* lobes of right lung and u]>iH»r lobe of left. Obliterative fibrous 
]>leuritis. Milijiry tnlMTcnlosis of lower IoIm's of both luTigs, spleen, intestinefi. 
and lymi)h inlands g«*ijcrally. Pjussivc congestion of liver. Chronic interstitiiil 
nephritis. TulwTcular ulcerati<»n of lar^^lx. 

C. R. 
P. M. C. 

T. W. S.: age, X\ years: nativity, Sweden: was admitted to the United States 
Marine Hosjiital. iK)rt of Sim Francisco, Cal.. May 10, and diwl May 31, 1901. 

Ilisfnn/. — Tw( > months prior to admis.sion patient caught a bad cold. Since then 
he liad lost al>out I •*> kilos in weight and became extremely emaciated and weakened. 



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104 MARINE-HOSPITAL SERVICE. 

increasing in size. Temperature ranges between H7 C.-3« C, biit the pulse is 
l)ecc>ming more rapid. Sedatives are necessary to allay the pain in hip and thigh. 
Patient finally Ix^came extremely emaciated, and died April 14, 1901. 

S'i'rropsy {eleven hoftrs after death). — Body is pale, except posteriorly, where 
blo(Kl has gravitated. Abdomen distended. Tumor 8*H.»ms to fill left half of cav- 
ity. The incision made from ear to ear was almost bloodless. Sknll cap glisten- 
ing white. Very little bloo<l in longitudinal sinuses. Cerebral spinal fluid api>ar- 
ently normal in 'appe{iranc<;, but reduced in quantity. Dura readily removtxl fn>iii 
brain. Aside from a general dryness of the tissues, nothing abnormal was found 
in the brain. Inci.si(m from chin to symphisis pubis showed superficial adiiH.»st' 
tissue almost entirely wanting. As abdomen was oi)ened, bloody semm followed 
the knife, part of whicrh was gelatinous in consistency. The hmgs were not col- 
lapsed. Right lung free: there were fi few pleuritic adhesions on left side. <.)n 
removal and sec'tion both were in practically the same condition, congested and 
studded with tuljercles varjnng in size from 1 cm. to 5 cm. in diameter, none of 
which had broken down. Weight; right, (MO grams; left, 780 grams. Pericar- 
dium normal; 20 c. c. of fluid. Heart soft and jjale; weight, 220 grams. Ante and 
post mort^iin clots in all the cavities. Valves normal. Aorta normal. The tumor 
occupying the lett side of tht* alxlomen was found to be a tubercular mass, chieflv 
involving greater omentum. The upper central portion lay between the stomach 
and transverse colon, separating them 12 cm. The wall was easily mptturd with 
the fingers, and a quantity of purulent, broken down omental tissue, abont 1,000 
c. c. , was taken out with the himds. Jjaterally . Ix^t ween the descending colon and 
the parietes, there was another and even larger c )llection of the same material. 
The abdominal contents were not adherent, except in the inmiediate vicinity of 
the tumor, and the adhesions were readily broken up, leaving the viscera appar- 
ently normal and showing that the process had been very ac^ute. Spleen 10 cm. 
in length, 7 cm. in breadth; color dull gray, capsule slightly wrinkled; on sec- 
tion rather dry; weight, 180 grams. Lelt kidney 12 cm. long, 6 cm. broad, and 
3 cm. thick; capsule strips readily. Numerous small hemorrhagic spots beneath 
capsule. On stn^tion a small quantity of turbid urine e8cai)ed from pelvis, the 
walls of which seemed to bo thickened and to have encroached upon the medul- 
lary sul>stance. Cortical and medullary i)ortion pale. Weight, 120 grams. Right 
kidney a trifle larger than left, but otherwise presented no marked difference; 
weight. 140 grams. Bladder contivined 100 c. c. clear urine and was apparently 
normal. Prostate gland not enlarged. Right testicle normal in size and api)ear- 
anpe. Stomach contained about 8()0 c. c. fluid. Mucous membrane covered with 
a thi(».k, gray coat. Small intestine contained a moderate amount of yellowish 
fluid. Mucous membrane pale and apparently normal. Large intestine presented 
no abnoi-malities until the descending colon was reache<l, the walls of which were 
thickened and contriu'ted to about cme-half its normal caliber. It was filled with 
small, hard, fecal ma.sses. No ulcers on the mucous membrane. Liver firm and 
pale. Section shows it to l)o dry and studded with tubercular masses, varying in 
size from 5 cm. to )3 cm. in diameter. The larger ones had begun to soften. 
Weight, 1 .540 grams. Mesent(?ric and retroiwritoneal glands genenilly enlarged. 

J. O. 

£. K. S. 

Aettte miliary tuberculosis. 

E. (t.; age, JJT; nativitv. Ireland: admitted to Unite<l States Marine Hospital, 
Baltimore, Md., De<-emlH^r H. 11)00: died March 10, IflOl. 

Fttinil// Jiisfori/. — Both mother and father living and w(»ll. aged 03 and 75. respec- 
tively; has four brotlxMs and three* siHt<*rs. all of whom are living and well. 

1*rrHi)iial histnrff. — Habits an» 1 airly good. Had the usual diseases of child- 
h(K)d. Syphilis t«n years ago. Pr»'seiit ilhie.ss started one week lK»fore admission 
to hospital, when tin' i>atient was taken with a sudden stit<*h-like pain in the left 
side near the nip])le. exa;<gerated by d<M'i> breathing and coughing. When 
atlmittrd th»^ condition had been gradually growing worse, although the patient 
was not extremely unconifort.ible. Inspection showed a moderate degree of 
inmiobility in the right chest, vith a slight bulging of the intercostal spaces. 
Tactile fremitus diminished. Percussion note flat all over right chest, not cliang- 
ing with position of j)atient. Auscultation revealed breathing of a tabular 
chara<-t(r in tin* extn*iin» ujixht axillary region. Left lung shows exaggerated 
respiratory sounds. Ap<'xlM*atdis])la<-ed to the left. Tcmj^erature. I10.0~ C: pulse, 
104; resi)inition, 2(). On December 17 the right jdeural cavity was aspirated and 
400 c. c. of serous fluid removed. On De<'ember 22 the chest was again tapped 
and 1 .000 c. c. of fluid removed. After (;ach aspiration the patient seemed to nel 



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MAEINE-HOSPITAL SEKVIOE. 



c. c. of serous fluid. Liver: Weight, 1.300 grams, slightly congested, othervise 
apparently normal. Oall bladder distended with bUe, Imt its dnct waa patnloiu. 
Spleen: Weight, 130 grama; qnito fim). l>nt nialpighlan bodies were indistinct 
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1(>0 MABINE-H09PITAL SERVICE. 

lol>6 uikI tliroiighoiit left Imif?: heart apparently normal: urinalysis iiep^ative: 
spntiiin (•ontuin<*cl many tnlxTcln bacilli; aftenuKm fever. This was a very 
serious case on arrival, and a fatal termination wjis ex])efte(l si)eetlily. Whisky 
and strychnia were administered as indit;ated, and the latter prolmbly prolonged 
life several days. Weaknet»s and <lyspna*a increased daily till death <.K'curre<l, as 
given al)ove. 

Nerr<)}}.sf/ (thirtmi hours (iffrr (h'ufh). — (-alvarium not removed. Tliorai: 
Anterior mediiistinum contained enlarged glands. Heart somewhat enlarginl and 
flabby. Kiglit ventricle dilati'd: left normal; all valves normal. Peiicardinm 
distended with al)out 200 c. c. of clear straw-colored fluid. Both lungs consf>lidattnl 
nearly all over. Pleural ca\ities obliterat^'d ])y Ann adhesions. Great vt»sspLs 
and nt-rve trunks normal. Diaphragm adherent to bases of lungs. AlHlonu*n: 
Omentum normal. S])leeu slightly enlarged and congested. Kidneys, supra- 
renal capsules, urinary bladdt»r, <.)rgans of generation, rectum., duodenum. stoiinicL. 
and gall ducts normal. Liver enlarged and congested. Pjmcreas and solar plexus 
normal. Mensentery loaded with tubt?rculous glands. Small and large intestiiifs 
in places showed transverse tulKM-cular infiltration, (xre^at vessels normal. Sum- 
mary: Dilatiilion of right ventricle, ju'ricarditis \vith effusion, tuberculosis of liwgv, 
adhesion nf pleural layers, congestion of liver and spleen, tul>erculosis of mersen- 
tery and intestines. 

C.R. 
P. M. C. 

K. W. (colored); age, ^o: nativity, Indiana: admittM to United Staten Marine 
Hospital. FortSt^mton. N. Mex.. January 2i), 11M)1; died May UJ, 1901. 

PnriiiKS hLstari/ {taL'cnfroiii ciiniral aotrs t)f midiad (tfflcer in vnmmawl iii 
Nrir Orictins, Lfi. ) . — Admitte'd to liospital DecomlK?r 25, 1900. Family liist*>ry iv^^i- 
ative. P*rs<mal history, mt;a.sles during childhood; gonorrhiea several times in 
hist four years. Present sickness began about three months ago with coujfh. 
w^hich has bt^jn getting worse. Hjus expectoration, fever, and night sweats. HaH 
lost H» pi Hinds in weight. Physical examination shows euuiciat ion, diminishe<l 
expansion on left side, increased fremitus on right side, impaired resonance over 
right apex, with i)ain on i»ercussion: bronchi ►- vesicular breathing at right apex. 
TulxTcle b.icilli and other forms of bactx.'ria in sputum. Case has not iinpnived 
in this hospital. 

Condition on arrival at Fort Stanbm: Weakness, hoarse voice, d^'sphagia, poor 
apix'tite. niglit sweats, emaciation, diminished movements of right chest, typical 
chest, nails, and gums. Vo.-al fr«*!uitns greater <m right side of chest. Dnlmew 
in right ap«.*x and ui>iK.'r IoIm^ and in left base. Tenderness on right side aiU over 
and in left iKise. In riglit upper lobe and ap(^x crackling rales and bronchial 
breathiTig. In middl<; 1< »be a larg»; cavity ant«.Tiorly with gurgling niles: x^osteriorly 
bronchial l)r»*arhing and crackling rales. Left lung shows liarsh respiration 
throughout and crackling rales in l)ase. Heart aj)i>arently normal. Urinalysis 
negative. Sputum cont^iined many tubercle bacilli and varices cocci. Blood 
examination reveah.Ml many xilasmodia. This was a bad case when he first 
arrive<l and stemlily lost ground. The throat was very painful and gave mnch 
tr«»ubl<>. Mjirch .*{ a seviTe hemorrhagcMK-curred. Insomnia was experience and 
was hard to oven-omi'. Death occurred May l.*J, 1001. 

Xrrntjfst/ {<ilu}nt si.rhtn hiHtr:* dftn' iidth ). — ( 'alvarium not removed. Rigor 
mortis fairlv well shown. Bodv much emaciat^'d. Larvnx shows mncons 
menibran<* in fp)nt swollen and greatly «'roded down to and involving the 
cartilairiiions structure «if the larynx. IJotli true and false vocal cords entin*ly 
dt'stroycd. TraelM-jil niuc'»ii> lUfiiibrane coii.i^estt-d and <'roded in small pin-iM)iut 
areas. (I-Nopliage;d mucoids nienibniiie pal«*: no ])oiiits of ulceration. TluT^wl 
;^l;md slmws sli.uht bilab-ral enlMru«iii«'nt. ]iot involving tlie isthmus. Thorax: 
Ant<*ii"r niedia.-tinuni eont;>in«-d cnljirv^fd tuberculous glands. Heart: Right 
vt'ntri<-lr dilate«l and on > ■i-tinii showed soino hy])ert.roi)hy of the my(K*ardium: 
left v<»ntricl«' of nonnarsi/;r. Liiv;,'" ant'*-niort«'ni clot at Ix'ginning of pnl- 
nionarv :«rterv. Endotardinni normal. All valv<'s n<»rmal. Pericardium mod- 
erately dist<'nd«'«l with cl'-ar fluid: its layers smooth. The lungs were almoitt 
«'ntirrly iiifiltrat«*d with cMscms material and cont^iined several largo cavities 
in ili»'ir ajnc's and in otlirr ]>:»rtions. Tln' pleural cavities obliterated by firm 
fibrous adlirsions, in'c.'s-itating tin* oj)ening of the lunvrs in situ. Great vessels 
and n''r\<' trunks norma!. Diaplira-rni ailhrrml to basrs of lungs and to colon. 
.■\b.loni»>n: Onh'iitnm norjnal. Snl'-'u adlu-n'nt at post'Tior border. Kidneys 
showed iinli>tin<'r <-orlical markini^ and swi'Uing <»f tin* (M>rtt>x. Snprareiud 
capsules show i»ost-mortem cy.stic degeneration. Urinary bladder partly fillad 



MARINK-Hi^sl'ITAl. ^KICVlrK. l(i«l 

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«-f ll»** t 4 :!y Wall* 

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162 MARINE-HOSPITAL SERVICE. 

rhoids. Has erosion of riglit vocal cord, with pain in Hwallowing and x)artia] 
aphonia. LaU»r a cavity discovered in right npi)er lol)e. Tubercle l>acilli foond 
in spntnm. Urinal vsis negative. 

F. J. T. 

Physical condition as noted on arrival at Fort Stanton was as follows: Suspicions 
scarson legs; typical chest and nails: limited motion of right chest; hoarse voice: 
cough and dyspntjea; increased v(x:al fremitus in right lung: dullness in right 
lung anteriorly merging into liver dullness: posteriorly dullness in upi)er lobe. 
Crackling rjiles in right lung, bronchophony above, prolonged expiration, dimin- 
ished breathing in base (left), in left lung a few crackling rales, and roaghene<l 
breathing in ajMJx. Heart somewhat displaced to right. Urinalysis negative. 
Sputum contained tul)ercle bacilli. This was a serious case on arrival. He 
improved for a time, but later on began to retrograde, steadily going down till 
the day previous to death, when a sinking sp(»ll was exi)erienced. from which he 
partially recovered. 

Xrcropsi/ {almut aevi'ii hours (tftcr death), — Rigor mortis moderate; posterior 
lividity not seen: calvarium was not removed. Thorax: Anterior mediastinal 
glands enlarged. Layers of right pleura adherent all over by firm fibroos adhe- 
sions. Left pleura adherent to chest wall , pericardium , and diaphragm. Superior 
and miildle lol)es of right lung firmly Ixmnd to chest wall and contained several 
large cavities filled with pus. Lower lolieand portions of upper lobes not entirely 
destroyed were devoid of air and filled with caseous material of granular consist- 
ence. Left lung had small cavity in aiK^x. Pleura covering left apex was scarred 
in radiating lines. Entire upi)er lolie infiltrated with caseous material. Lower 
l()l)e showe<l miliary nodules throughout. Small amount of frothy fluid preyed 
from cut surface. The smaller bronchi tM>nt4iined pus. Heart of soft consistence. 
Anterior c<)r<mary ariery twisted in course. Aortic and pulmonary valves com- 
petent. Riglit side of heart presented evidences of dilatation, with hypertrophy. 
Tri(*,uspid orifice admitted four fingers readily. Left heart normal thronghont: 
mitral orifice admitt€>d three fingers. Endocardium of entire he^rt smooth and 
shining. Myoc*ardium at interventricular septum showed white lines, indicating 
fibrous change. Beginnings of aorta and pulmonary arteries smooth. Layers of 
pericardium free. The jwricardial cavity contained a small amount of straw-ool- 
ored fluid. Tongue soft and flabby and very i)ale on cut section. Mucous mem- 
brane of almost entire larynx eroded. At site of <»rosions were nodular swellings 
of large pea size. Edges of ulcerations indefinite* and the lK)rdering mucous mem- 
bnine swollen. Vocal cords, true and false, entirely destroyed. Tracheal mvcons 
membrane strongly injected and covered ^vith purulent mucus, but was intact 
Mucous membrane of cesophagus i)ale. but smooth. Peribronchial lymph glands 
enlarged and deeply pigmented. Abdomen: Peritoneum smooth and shining. 
Pelvis contained some fluid. Oreat omentum covered intestines in front. Sep- 
arable fil )rous a<lhesi» )ns between right lobe of liver and diaphragm. Spleen adbe^ 
ent at posterior border and to tail of pimcreas and splenic fleziire of coloQ. 
Splenic substance softened and showed several small caseous areas, especially 
numerous just bi»neath capsule. Kidneys of small size and had adherent capsules. 
Cortical substiince narrowed. Glomeruli showed as glistening points. Ck>rtical 
markings indistinct and points of fibrosis present. Suprarenal capsule nonoiL 
Urinary blad<ler contained a small amount of urine. Organs of generation no^ 
mal. Stomach normal on peritoneal surfiwre. Liver shows the centers of the 
lobules to 1)0 darker than those of the i)eriphery. Pancreas a<lherent to spleen. 
Througliout ileum tul)ercnlar infiltrations of varying size, showing tendency to 
encircle tlie lM)wel wall. Lymph channels running from these XH)intA tothe omen- 
tal lyni])h glands were infiltrated and nodular. Lymph glands enlarged and 
caseous. TnlM'rcnlar foci esiM.'cially numerous near ileo-caKMil valve. Beginning 
of «*j)iK'Tidix and adjacent cjecal wall in same condition. Large intestine con- 
tained Mnaller tul)ercular foci, more scattered. Summary: Tul)erculo8i8 of supe- 
rior an<l middle IoIk's of right lung and upper l<»be of left. Obliterative fibrons 
pleuritis. Miliary tuberculosis of lower lobe-^ of both lungs, spleen, intestines, 
and lymph glands generally. Passive congestion of liver. Chronic interstitial 
nephritis. TulKTcular ulceration of lar\nix. 

C. R. 
X. M. V. 

T. W. S.: age. ',V.\ years: nativity, Sweden: was admitted to the United States 
Marine Hosjntal. i>ort of San Franci.s<'o, Cal.. May 19, and died May 21, 1901* 

HiMforff. — Two months prior to admission patient caught a bad cold. Since tfaieii 
he had lost about l") kilos in weight and became extremely emaciated and weakened. 



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164 MARINE-HOSPITAL SERVICE. 

increasing in size. Temperaturo ranges between J37 C.-38 C. , but the pnlse is 
becoming more rapid. Sedatives are necessary to allay the i>ain in hip and thigh. 
Patient finally became extremely emaciated, and died April 14, 1901. 

Xi'crojhHi/ {eleven hourn after deaih), — Bo<ly is pale, except posteriorly, where 
bhxKl has gravitated. Abdomen distended. Tumor 8iH*ms to fill left half of cav- 
ity . The incision made from ear to ear was almost bloodless. Skull cap glisten- 
ing white. Very little blood in longitudinal sinuses. Cerebral spinal fluid apiiar- 
ently normal in appearancio. but r(?duced in quantity. Dura readily reinovt»il fprjui 
brain. Aside from a general dryness of the tissues, nothing abnonnal was found 
in the bniin. Incision from chin to 8ymi)hisis pubis showed superficial adipox* 
tissue almost entirely wanting. As abdomen was oi)enod, bloody serum followed 
the knife, part of which was gelatinous in consistency. The lungs were not col- 
lajMjed. Right lung free: there were a few pleuritic ailhesions on left side. On 
removal and secticm both were in pn^ctically the same c^mdition, congested and 
studdcid with tubercles varying in size from 1 cm. to 5 cm. in diameter, none of 
which had broken down. Weight; right. 640 grams: left, 780 grains. Pericar- 
dium normal: 20 c. c. of flui<l. Heart soft and pale; weight, 320 grams. Ante and 
post mortem clots in all the cavities. Valves normal. Aortii normal. The tumor 
(Xicupying the left side of the abdomen was f oimd to be a tubercular mass, chiefly 
involving greater omentum. The upper central portion lay between the stf^mach 
and transverse colon, ^•eparating them 12 cm. The wall was easily rupturc<l with 
the fingers, and a quantity of purulent, broken down omental tissue, about 1.000 
c. c. , was taken out \Nith the hands. Laterally, l)etween the descending colon and 
the parietes, there was another and even larger c Election of the same material. 
The alxlominal contents were not adhertmt, except in the immediate vicinity of 
the tuniDr, and the adhesions were readily broken up. leaving the viscera appar- 
ently normal and showing that the process had l)een very acute. Spleen 10 cm. 
in length, 7 cm. in breadth; color dull gray, ciipsule slightly wrinlded; on sec- 
tion rather dry; weight, 130 grams. Lelt kidney 12 cm. long, 6 cm. broad, and 
3 cm. thick; capsule strii)s readily. Numerous small hemorrhagic 8|X)ts beneath 
capsule. On section a small quantity of turbid urine escaped from pelvis, th*.? 
walls of which seemed to be thickened and to have encroached upon tne medul- 
lary substance. Cortical and medullary i)ortion pale. Weight, 120 grams. Right 
kidney a trifle larger than left, but otherwise presente<l no marked diflTerence: 
weight. 140 grams. Bladder contained 100 c. c. clear urine and was apparently 
normal. Prostate gland not enlarged. Right testicle normal in size and apjiear^ 
anjre. Stomach ccmtained alx)ut 5500 c. v. fluid. Mucous membrane covered with 
a thick, gray <roat. Small intestine crontained a moderate amount of yellowish 
fluid. Mucous membrane pale and api)arently normal. Large intestine presented 
no abnormalities until the descending colon was reached, the walls of which were 
thickened and contriu-ted to about one- half its normal calilier. It was filled with 
small, hard, fecal masses. No ulcers on th«* mucous membrane. Liver firm a^ 
pale. Section shows it to Ih) dry and Htudd(»<l with tubercular masses, varying in 
size from 5 cm. to 3 cm. in diamet<^r. The larger ones had begun to softien. 
Weight, 1.510 grams. Mesenteric and retropc^ritoiieal glands genenilly enlarged. 

J. G. 

E. K. S. 

Acute luilinrij tuberenlttsiH. 

E. G.; age. 87; nativity. Ireland: admitted to United States Marine Hospital, 
Baltimore, Md., De<-emlM^r 14. lOOO; <lied March 10. 11M)1. 

Fitinihi hisfnn/. — Both motluT and father living and wi^ll. agedfil] and 75. respec- 
tively: has four brothers and tliree sisters, all of whom are living and well. 

I*rrs()inil histin't/. — Habits are 1 airly g<)od. Had tlie usual diseases of child- 
hood. Sy])l)ilis t«'n years ago. Present ilJiirss started one week lH?fore admissioD 
to hos])ital. when the patient was taken with a sudden stitch-like i)ain in the left 
side near the iiiii])le. «'xa^;r«'ratid by de<'p ]»reathing and coughing. When 
a<lmirt«*(l th«» (Mmdition had bei'u gradually growing worse. altlKmgh the patient 
was not <»xtreniply uncomfort ibl«*. Inspection showed a moderate degree of 
immobility in the riglit chest, vith a slight bulging of the intercostal spaces. 
Tactile fremit us diniini.shed. Pereussion note flat all over right chest, not cnang- 
ing with jMisiti'in of ]>atient. Auscultation n^vealed breathing of a tubular 
<'haract<-r m thr extreme upjx^r axillary r^-gion. Left lung shows exaggerated 
respiratory souinls. Apex beat dis]>lae«'d to the left. T«*m])erature. IJO.O ' C.; pnlse. 
104; res])inition. !•*<). On December 17 the right ]»leural cavity was aspirated and 
4(Mj c. c. of serous fluid remove<l. On D«H'(»ml)er i''2 the chest was again tapped 
and l.G<X) c. c. of fluid removed. After each a.spiratiou the patient seemed to feei 



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174 MABINE-HOSPITAL SERVICE. 

losis, which seems to be clearly shown in tlie clinical notes from St. Louis. At 
first we were unable to demonstrate the bacilli in this man's spiitiim, and when 
they were fonnd they were few in numbers and stained very faintly. During his 
stay at the sanitarium his cough had almost disapjwared and he only raised a 
slij?ht amount of mucus in the momiuj^. The lun^^s were infiltrated with carlxMi 
dust, showing that the man had been a fireman, and there were pleuritic adheidon 
bands tm both sides; otherwise the play of the lungs was free and nonnal. These 
pleuritic bands were of great interest to us. They had pulled out into round conls. 
and some of them were and 8 imrhes long, and they did not restrict the mov»^ 
ment of the lungs at all. The bronchial glands were hard and indnrated aud 
contained deposits of coal dust. We did not mount sections from the glands, a** 
they seemed to be typically tuberculous. In the right lung was fonnd a small 
cavity, with wide bands of connective tissue running through in several direction!!. 
This cavity contained some purulent matter, and was i)robably the source of the 
small amount of sputum and the slight cough. This cavity was nearly healed. 
There were two other small tubercular deposits which were entirely encapsulated. 
In the left lung there were two small deposits also encapsulated. There ^vbs 
a small portion of the ai)ex of the loft lung which was cux>-shai)ed from the 
outside, and, in going into it, it was found to be a mass of connective tissne. 
This was probably a healed tul>ercle cavity. We were also able to locate the other 
ca^ity mentioned in the right lung merely by this cupping in of the Inng tisane 
showing where the connective-tissue bands had contracted into scar tissue, invert- 
ing, as it wore, the outside portion of the lung. Aside from the conditions men- 
tioned . the lungs were perfectly normal. We found in the bronchioles and bronchi 
and the trachea considera])le dark fluid, which had been aspirated daring the 
vomiting si)ell while under ana\sthesia. The heart and great blood vessels were 
normal. On oi)ening the abdomen, small, hard, pearl-like bodies were noticed, 
studding the i)eritoneum in considerable numl>ers. They did not feel tothetonch 
like tubercles, and they also ha<l a whitish apx)earance. In the great omentum 
there were several indurated glands. The liver, stomach, duodenum, and pancreu, 
were one agglutinated mass and had to be dissected apart. The waUs of tl» 
stomach were very thin and could Ix) easily torn with the fingers. TTie pnrse-string 
suture inserte<l during tlie operation had held. In the dependent portion of the 
stomach there was a large ulceration which had nearly eroded the entire thickneM 
of the stcmiach wall, the porit^meum being the only remaining x)ortion. The 
cancer was of annular form, filling in the entire p^'loric end of ttie stomach to i 
thickness of al>out one-thir<l of an inch. A small rubber catheter conld not have 
been passed through the pylorus, and. besides, the canal was very tortuous. The 
upi)er ix>rti(m of the pvlorus was infiltnited, and the gall bladder was almost 
entirely obliterated by the deposit, except the greater extremity, which contained 
six small gallstones. The cancer ha<l only infiltrate<l the liver Bux)erficially and 
hatl n< >t invade<l the deep structure. The head of the pancreas was badly involved. 
The spleen was slightly enlarged, and the suprarenal cai)sules were indnrated. 

Microscopical cvaviinatioii. — The* sections of the tumor were fonnd to he 
scirrhous. 

J. O. C. 
Tubercle of the InntjH, 

E. W. : age, :{.'); nativitv, Illinois: admitted t^) the United States Marine Hospitil, 
Chicago, 111.. Septemlwr 1, IIMMI, and died October 28, 1900. 

Uisiorii. — Father di(Ml of influenza: mother died of astluna. Two sistendied 
of bronchitis, and one brother as tlie result of an accident. The only previous 
illness which patient has had w;is malaria a few years ago. Present illness is of 
alxmt (>Tn> year's duration. It liegan with cough, wliich gradually iucraksed in 
wn-erit y . (*)ne month ago, during a paroxysm, patient hiwl a hemorrhage. At first 
bright r<>d blood wjis exixn^torated, later dark clotted masses in a^nsidcrable quan- 
tity were exjH.*lled. At ]>resent patient is weak and emaciated, has hard cough- 
ing si)ells, and sometimes vomits after eating; he also has anorexia, night sweats, 
an<l evening rise of tenii)erature. Bowt Is are constipatt^d. PhysiciU examination: 
Defective exjiansion. but in(Teas<Hl v<ical fn^mitns over right lung; dullness over 
right upi>er lobe, more in.irke<l anteriorly; on auscultiition whispered pectorilooiV 
and tubular expiratory breathing over upper right lobe anteriorly. Below tw 
the .sounds are distant. Tubular breathing over left upi)er lol)e anteriorly, and 
p<»st.eriorly: crepitant rales heard below eighth rib posteriorly on the leni^* 
Bfxly shows a marked degree of ema<'iation. C4eneral condition is bad. Tnberde 
l)a(*iila present in sputum in abundance. Trt^atment wtis pun^ly aymptomatic 
The disease progressed quite rapidly, patient being confined to bed in a short tiiMi 



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176 MARINK-HOSPITAL SERVICE. 

'*Frltnum/L'0, — After repeated exaininatioiiH tii])ercle l)acilli found. Teiniiera- 
ture had ranged from 37 to ;^8.5. 

"* March J, — Discharged improved. Readmitted for tubercle. 

''March ;^i. — Examination shows on insi)e(rtion: Exitamrion of chest fairly gwid. 
right lK»tter. Palpation — vocal fremitus normal. Percussion — slight dullness of 
left lung iKwteriorly at l)ase. Auscultation: Respiratory sound exaggerated over 
right chest, suppressed (^vor left lung posteriorly at base; vocal resonance dimin- 
ished over left lung at base iK^steriorly. 

"March 4. — Some swelling of right ejndidymis. 

*' March Jo. — Swelling of epididymis and testicle continues: now deluded enlanpe- 
ment; quite painful. 

"'Mai'ch Jo. — Swelling somewhat increased in size and more X)ainful: i)ain is also 
prolonged along cord. 

** March !'.». — Pain and swelling less marked. Patient weighs 168 iKmnds. 

"'March J:i. — PasstMl two or three yellowisli ]M)dies, the size of a pea, by urethra. 
Aspiration with hnHMlennitt over fluctuating i)oint gives a small amount of bloodj 
effusion, but no tubercle bactilli found in it. 

March J7. — Abscess iK)inting at upiwr end of tewticle opened and about lOc.c.of 
pus obtained. 

"March JS. — Tul)erclo l)acilli found in pus from testicle. 

"Ajiril J. — Testicle remains «^nlargod and pus is dischargecl from sin ns in tes- 
ticle. 

"April IK — Testicle removed (chloroform aiiiesthesia). Pus and caseous mate- 
rial round in epididymis; t^'sticular substance riddled with tubercles. Qanze 
dr<'iiu inserted. 

"April ::n, — There has been some discharge of jius, but the wound is now gran- 
ulating nictly. 

''April ,»'!,— In ytill troul)led with deficient hearing and discharge from left ear. 

"May 7. — Patient is well nourished; coughs but little; temperature has been 
uormai for several weeks. 

•J. M. G. • 

Condition when admitted to the sanitarium was as follows: 

June Jfi. — Physical exiimination: Inspection shows full chest, typical nails and 
gums, movements of chest even, skin in good condition. Palpation — ^vocal fremi- 
tus nearly alwent in bases of lioth lungs to alwve level of nipples. Porcuawon— 
no iK)sitive dullness can Ik? demonstrated in left apex, as clinical she.^t fr ^m San 
Francisco mentions; marked dullness in bases of lK)th lungs to about level of nip* 
I)ltjs. Auscultation — vesicular nmnnur very faint in lower half of each lung. 
anterior; i)osteriorly. bronchial breathing at ))a.se of right and cogwheel respira- 
tion at base of left; roughened breiithing in the other jwrtion of both lungs; heart 
ap])arenily normal in all nsiKM'ts. 

From tlie very start this patient complained of severe and persistent headaches 
(frontiil). which later on be(^ame general. He was always dull and stupid and 
inclined to l>e filthy in his habits, and he proliably swallowed the simtnm froni 
time to time. On July :21 examination was made of left ear, and it was fafnnd 
that the eardrum had bi'^n previously destroyed. The headache at this time was 
verj' severe, and cijreful wat<'h was kept over the mastoids, thinking that the 
headaclK s might 1 e caused from mastoiif dis(;ase. On July 24, i^ter several chills, 
witli high t(»ni])erature, he was found to hjive a large tul)ercular pneumonia at the 
l>ase of the l<*ft lung. Tliis con<liti< ai seemed t > grow worse. On August *Jt^ tuber- 
cular ])iiHumonia dev('l(»iM^d in base of right lung. At this time the man became 
very sl<-k; was delirious and hard to control; did notresj)ond to stimulation. The 
fever gradually suljsidtid and the teiui)orature ran subnormal to tiie day of his 
death. Dird from exhaust ion. 

Srrrnpsif {ri(jhfrfii hours a/hr fhatfh). — Rigor mortis marked; body wellnoar- 
islied; no scars exc«'pt in scrjtuin. sliowing where testicle had been removed at 
pr«'vions f»iM»ration. Tli»' cal varium was njnioved. and the dura was foundadherent 
in srvrral j»la*'(\s, ps]M?(!ially along tlie longitudinal sinus. Near the sinus were 
alwcssi's which wtre cut int«>, but unfortunately none of the pus was secured for 
microscopical exauiination. Near thn longitudinal sinus the dura was also 
adherent to the arachnoid, and the arachnoid and pia were firmly bound down to 
the brain tlirougliont. Tlie ara<'hn<)id was e norm( nisi y distended with a clear 
white sennu whicli cfuitaincd a few floi-culi. The bliKxl vessels of the brain were 
distended to sucli an extent that it must have cause<l a certain amount of cuoi* 
pression. It was not icc<l that the spinal canal was also greatiy distended with 
this clear fluid. On turning the brain out and severing the spinal cord aoiDe of 
the fluid was coll«M;ti>d on slides for microscopical exammiation. In aection of tha 



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178 MARINE-HOSPITAL SKRVICE, 

Ix'd. and there he remained till he died from sheer exhaustion on the 10th of Novei»' 
her at H p. m. 

Xvcropsf/ {fireirv and a half hours after death), — Shows the body of a poorly 
developed, poorly nonrislied, twlnlt, white male. alK)iit !.(> meters high and weigh- 
ing 47 kilofH'i^ns. Rigor mortis has entirely disappeared in the npper limbs and 
is very Blif^fht in the nether limbs. HyiK^stasis is very slight. A few scars, circular 
or oval in shape, are present over each kn(^. No anlema is present. The snbcnta- 
i:eons fat is almost eiitirely absent, the small amomit present being very dark io 
color. Tlu? superficial IjTnphatic glands are not enlarged, with the exception of 
the two hii'hest anterior cervicals. The alMlominal cavity contains abont l.n^l) 
c. c. of cl<nir serous fluid. The omentum is almost devoid of fat, but is otherwise 
normal. The ant< ri< »r mediiLstiimm is normal, except that it contains a few tuber- 
cular glands. Tlie pi'ricardial cavity cont^iins about 50 c. c. of dear serons fluid, 
but is otherwise noi'mal. The right pleural cavity is entirely obliterateil by 
stringy adhesions. These are esiK»cially dense and firm over the right ai)ex. The 
left pleural cavity is almost in the same condition, except that the apex of the Inng 
is almo: t entirely free of a<lhesions. The right lung can not l>e removed l)e<*ande 
of the dense, iinn a<lhc^i<^ns which bind it to the thoracic wall. Its snrfac^ei:* 
iKKlular with tulK'rcl(»8. The apex is entirely c< mm >lidated. and on section is found 
to (contain a large sinuous ca\ity , which is filled with a greenish creamy pns. Tbe 
left lung weighs 700 grams. Its apex is almost entirely consolidated, as is also 
its base anteriorly. Posteriorly it is crepitant and emphysematons. The bron- 
chial glands are enlarged. The cut surface is studde<l with txiljercles, some 
showing ix*rii)heric masses of pigmented s(tar tis.siie. The tendency to breaking; 
<lown is more marked at the center of the lung than at the base. The heart 
weighs IW) gnims. It is small and ])al(^ and shows (m the anterior surface of iu 
ix'ricardium an irregular white milk s]>ot 5 cm. in diameter. Its apex is made 
up entirely of the h»ft ventricle. The aorta is suifill and elastic and shows a few 
thickened s]M>(s on its intima. The left ventricle contains one lardai^eona dot 
Its muscle is ])ale and flabby. Tlie aortic valves are normal, as are also the mitral, 
except that they show a few i>iitches of sclerotic tliickening. The right ventrirle 
is thin and flabby and contains also on«> lardaceous clot. The prOmonic and tri- 
cuspid valves are nonual. The right auricle is slightly dilated. The liver weigbi 
1 ,250 gnmis It is small in size. Its outer surf a(*e presents nothing abnormaL Its 
cut surfa(!e shovvs thr; (-enter of the liver lobules to l>e somewhat depresaedand 
pnride in color. The ])ancreas is normal. The spleen weighs 150 grama. Itt 
out4?r 8urfa<x^ pre.'^ents no abnormality except a few white thickened B^H^ta on the 
cai>sule. Its dinH'iisions are UJ.t* cm. long by H.2 cm. wide by 8.8 cm. thick. Its 
consistency is normal. Its cut surftwe is dark reddish-gray in col(»r. The trabeo- 
uhe and Malpighian bodies are quite distinct. The right kidney weighs 175 grama. 
It is quit «' sTiiall. Peri nephritic fat is almost entirely wanting. The capanleis 
very adh<^rent over its anterior ]Kirtion. The outer surface is i>ale ana fairiy 
smiN)th. A small stellate depression, red at 1h<» lx)ttom, is seen on its convei 
border. The cortex is thin and fairly tnmslucent. The jwlvis of the kidney is 
normal, except tlmt it is devoid of fat. The consistency of the kidney is firm. 
The left kidney weighs 1 7.'J grams. Its capsule strijw with some difficulty. Its 
outer surfa<-(? is very fin<;ly granular: otherwise it is similar in all respecta toils 
fellow. The stonnu'h is small. Its mucous membrane isi)alc. There areaome 
adhesions In^tween this organ and the transverse colon. The intestines are moHt 
and almost <'ollai)s<Hl. Tlicir mucosa is dotted with shallow oval ulrera, whoiB 
long dianu?tf.T runs ])arallfl to the transverse diameter of the l)owel. The meaeiir 
teric glands are (»nlargtMl and caseated. The dura iind pia maters are normaL 
The subpial fluid. li(nvr'V<>r. is very exces.siv(? in amount and elevates the pia mater 
considerably from the surf5ice<»f the brain. Tlie fluid is clear and seruna. The 
brain weighs IJOo L'rams. Its cut surface is slightly (edematous, but otherwine 
shn\Ns no }tl)inmn!ility. The cau.-ur of death is exhaustion incident upon tabeivic 
of the lung and the bowel. 

M. E. L 
J. M. O. 

MiornHi'tiiiir rrport . — Lung: The s]»ecimen is almost entirely c^>nsolidated affl 
consists of illy <l<;Hned netrrotic areas, with ])eri])heric imisses of lymphocytes .v^l 
epithelioid cells, (xiant cells are ])resent,bnt n»it in very large numbers. Th© 
surrounding lung is hyiK3r;emic. Liver: Upon examination with the low powv 
ob.iective. the center of each lobule presents a brown ap|)earance. More minotB 
examination shows this to 1m? due to the fact that the cells in the center of tha 
lobules are tilled \\'itli tine, brown granular ])igment: otherwise the liver is 



XAKlNK-HiiHl*ITAL KKKVirK. 1 7*.» 

!• n'lnajU. Ki«1ih*} At ntnilMr intfrinU U<tiiHt)i tSi i-ain-nlt- .'in- 
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tf o^cnlAl^l flnifl. ami hrn< rniif tlifn- a iiiNti] nt.n 1.1111: •! Iiynlinf t-aM. 

lA2nskiAii Uallt« am* Ptiuill an«l ulimiikfii frMin tlii'-r t'a|Miili- spli^'n: (*:i«- 
ill(«tl]r ihirk M>il tlt"iiM". otIirrwiM* iiiiniml TtaU-'-tilji' 111 1iki> r«iiHlili iti. 
(luMi lB«lir« an- int^ilar in «*ntliii«< aii<l 1 h*^ \\ |hii kiil. T)i>- Mali'i^hiaii 
wm ■fei'w A thfti krninff «>f ihi* iiitimn. I*ulp 1- )i> iH-r.riiiii Tin- f-t-II^ an* 
f lyvaj^k** «1r« AIhI «i'l«-«<tl «'«*llii. Ki)>n>Ma*>1'* ]>1a-|i.^i I f!U ,iTii| |MilyiMiir- 
rSmr* ar*> t ••fn|Hi mill ••!> frw. In tin* pulp tln-r* iii.i\ U> •>•- n .1 fi-w -ii<h11 
t»r mi*m0 m*irr**tiu*Un\ tiy a r^fii^- nf i>lii|iliia \1' -> ;itpi i-t<iThf!l>'iil • flU Nn 
evil* «r^ it«il4f 

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T *»-^ ''. iuilivit\. Itn^ti. .Mlinittfil !.. r:>.\ ilt rn • l|ii»|iira] . S«-.ttT!<. 

f ^^ {''Ati'-til •Trtt««l that thr<-<- wi^'k'« pn \:i>if>I« ):< \u%*\ falli n «i>wii ;i 

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k»S th^ <!>a|i|j*i A <iii • &rni'>ii \^t r> tYi- • •tilv tliiiik''* ''f ^hiih )i iiipliiii'-*!. 

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pvn tr -"sSW*! mn* h Hith a 1 ••iik'l) 

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172 MARINE-H03PITAL SERVICE. 

Remain<ler of the lung is congested and codematons: has several small cavities 
and hard, fibrous tubercules hero and tliere. Right lung: Ai)ex contains a lance 
cavity; bronchi arc congesttMl and the bronchial glands enlarged. The reniaiu- 
der of the lung is in a condition similar to left. Abdominal cavity contains '»•>» 
c. c. of dark-yoll<nv. turbid fluid. Omentum very sc^intily supi)iic<l with fat. 
Liver: Weiglit. 1,786 grams; outer surface normal, somewhat i)uri>l<? in color: 
cut surface puri)lish-brown in color, with a few yellowish- white pinhead nodxdes 
scattered over it. Gall bladder filled with dark-yellow^ bile; duct^ i^atnlous. Left 
kiilney: Weight, 100 grams; perinex)hritic fat scanty; nothing abnormal on 
surface; capsule strips easily; t-ut surface shows cortical portion al)ont 1 cm. 
in thickness; the medullary rays are tiuite distinct and cortical Bulwtance of ii(»r- 
mal color. The mali)ighian pyramids api)ear (juite normal. Then* are two small 
cvsts in the cortex and a small white spot in one jiyramid. Right kidney: 
Weight, 140 grams; nothing abnormal on surface; capsule strips readily; e»'C- 
tion shows dark-i)uri)le color; cortex thickened and mottled, medullary rays and 
malpighian i)>'ramids very indistinct. Spleen: Weight, 313 grams; size, 15 cm. 
long, 12 cm. wide, 7 cm. thick; (luite firm in consistency; cut surface dark- 
purple in color, with tralxicular and malpighian btnlies ^^.sible. Intestines: Con- 
gested thnmghout, and slunvs many cicatrices of old ulcers, with many recent 
ones scattered throughout lx>th large and small inte.'^tines. No adhesions. Mes- 
enteric glands enlarged. Brain: Dura mater api)ears normal; excess of fluid in 
sulxlural space: a few adhesions over the frontal lobe. Otherwise the brain is 
normal. 

Microscopic report. — Pericardium: This, as a whole, is verj- mnch thickened 
and shows an immense deiiosit of fibrin. Nearest the heart it (consists of fibroos 
tissu«», cells, and newly formed cainllaries, thus Innng thoroughly organized awl 
evidently chronic. The capillaries do not extend to the free surface, and here 
there are only a few cells inters]H^rs(?d through the fibrin, which is of later origin. 
At one iK>rtion is sc^en what, ^Wtli other evidences, apiwars to be a tnliercle. It 
consists of a well-<ircumscril)ed collection of epithelioid cells, lymphotrytes, and 
connective-tissue cells in a stroma of dense fibrous tissue. Several well-defined 
giant cells are sf?en in other portions of tlie pericardium. Heart: The section 
shows a lUixlerate amount of congestion. The cells are quite indistinct, but the 
nuclei a])i)ear well stained. The cross striations can not be made out. The cells 
in various places show a deposit of small brown pigment granules, indicati>'e of 
brown atrophy. Lungs: Conglomerations of tul>ercles are seen in various fieldfl. 
consisting of fibrous tissue, epithelioid cells, lymphocytes, and giant cells. Some 
of these sliow marked evidence of castration, and consist of broken-<lown cells and 
nuclear debris. The r(*maining alveoli arc dilateil and emphysematons. Their 
walls are somewhat thickene<l. The Ijronchi are hyperiemic and in places gieatlj 
thick(»ne<l. Kidneys: Both kidneys show congestion, one a great deal more than 
the other. Tlie cortical i)ortion shows at pliu*es a proliferation of connective tiseoie 
extending down as traln'culw from the capsule, and (tonsisting of connective- 
tissue cells, l>Tnpho(^ytes, and epitlielioid cells. The scjction shows an immenM 
numb«»r of lymphocytes throughout. The Malpighian bodies are in places greatly 
congested. The convolut<*d tubules over most of the field anpear quite nonnil 
but in iM)rtioii8 there is an increase of interstitial tissue and f)eginning degenera- 
tion of the jiarenchyma (relLs. The conducting tubules are normal. Spleen: The 
tnilxN-ulie aijjM'ar greatly thickened all over the section. The Malpighian bodies 
an? enlarged, and a few of th(jm show hyaline degenenition. Tlie capsnle shows 
an in<n'ase<l number of connective-ti.ssue cells. The bl(KMl vessels show thicken- 
ing of the intima and ridventitia. Tliere is some slight pigmentation of the {laren- 
chyma cells. Liver: Tliis ap])ears normal, with the exception of a slight con- 
gestion and a beginning cvanotic atroj^hy. 

A. M. M. 

J. M. G. 

TuJun'vh' of IniHj ond r(tnccr of sfrnnach, 

J. T.; age, .Vi years; nativity. New York: admitted to Marine-Hospital Sanita- 
rium, Fort Stantiin, N. Mex., 'March 17, lUOO; died Sc]>temlK^r 11, 1J)(W». 
The fallowing is taken from clinical notes furnishe<l from St. Louis: 
*' HiHtonj. — Family hi.story, negative; was i\ <lrinking man until eighteen months 
aj^o. Prewnit trouble dates bacrk to two we(»ks, which l)egan with sonr stomach 
and nausea aftt>r eating, though sometimes felt all right. Apx)etite good; can eat 
anvthing. C'oflfte seemed to hurt ])atient. Never vomite<l any blood. Puns 
nuliate at times all over alwl omen. AhnaliztMl tenderness, which i>atient feels, 
lies in meeting lines "i inch(;s below the xix)hoid ap|>endix. Bowels moved twu^ 



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182 MARINE-HOSPITAL 8EEVICE. 

1,650 f^rams; conjireRted at base, with 120 c. c. of clear thin serons flnid. On sec- 
tic »ii the brain appears normal with tho exception that the ventricles contain an 
abnormal amount uf lluid (iJOc. c.) and the color of the cerebellnm is darker 
than usual. Spinal cord slightly congested and surrounded by abnormal amonnt 
of flnid in iha sul)arac!hnoid si)a<'e. Several adhesions exist between tbo piamater 
and duramater at the vertex of the cerebmm. 

G. J. S. 

J. M. G. 

Tuhervulosia, noutf* miliary. 

P. McG.; age, 82; nativity. New York: admitted to United States Marine Hofr 
pitaL St4ipleton, Staten Island, November 26, 1900; died November 38, 1900. 

Famili/ hitftory. — Father living and in good health; mother died in cbildbirth. 
Four sisters died of cholera. One brother was paralyzed, one died of pnenmonia. 

Past hinfori/. — Indefinite. Patient in a very weak condition and was not ques- 
tioned closely as to condition of health ])revious to present illness. Drinks ccmsid- 
erabh?. Said he was always well until the bi^ginning of this month. 

Pi'vHt'nt history. — Dates his present condition from November 8 of tbis year, 
when he was drinking t^) excess. Remained on a spree for several days. Anpetite 
w.'ispoor; nauseated. es]>ecially in morning. Nervous, couldn't sleep; complained 
of pain in abdomen and diarrhea. Condition rapidly became worse and he entered 
hospital. On aibnission complained of nausea, anorexia, diarrhea, pains in abdo- 
men, and weakness. 

Knt mi nation. — Inspection: General appearance poor; emaciated: aniPinic: 
sordes on teeth and lips; tongue coated heavily, dry and cracked. ClaviclM 
prominent; expansion p(X)r, abdomen flat. Palpation: Fremitus increased over 
apices of l>oth Imigs, esi)ecially right. Tenderness over large intestines, especially 
over descending colon. Gurgling in right iliac region. Liver felt below ribs. 
Percussion: Dullness over apices. Auscultation: Blowing breathin;j: over both 
apices: snl)crepitant and fine mucous rales over rest of lungs. Temperature 
slightly elevated: pulse 88; respiration 30. Has cough, with mnco-pamlent 
exi)ectoration. 

Treatment. — Milk diet, salol. lead, and opiiun pills. 

Xoiunnhrr 'J 7, V.nfo, — General condition worse; passed a poor night; bowels 
moved fifte(»n or twenty times; iuovem(*nts fluid in consistency, y^lowiah color, 
and l:inre in amount. Temperature in morning 37.4; respiration 80; pnlseSO. 
Slight cough, with muco-imrulent expec^toration in small quantity; pain in abdo- 
men; weiikness jirofoun*!. Diarrhea continued unchecked; general condition 
alnrnt the same. 

Sovi'mbvr ,:s. — Passed a poor night: s(jile<l bed several times; diarrhea penEUta: 
movements litiuid. light brown in color, and amount alx>ut 1 qnart with each 
eviwuation: has hectic flush: tongue coated: very little appetite. Temperatiire. 
H^^.O: pulst; rapid; respirations shallow; abdomen markedly tympanitic; pain 
along colon severe: tenderness over int'Ostines; coughs but little, and not mnch 
ex]NH'toration. Hi^ says milk causes cram]>like pains in the stomach; atimnlation 
prescribwl. Found unconscious by nurse shortly after morning sick call, and he 
died at 11.20 a. m. 

.\vrntjisy {twrniy-fonr h on rs after death). — Bo<ly of a male, apparently 40 years 
old: small stature, mus<-les poorly develox)e<l: amount of subcutoneona fat small; 
rig(>r mortis marked: suggillations in dejKjndent parts of IxKly. Anterior medi- 
astinum normal. Remains of thymus gland not found. Pericardium in normal 
IKJsirion : amount of fluid in in'ricardial siic alnnit 50 c.c : jn'rica^dial walls normal. 
Ib'art in normal position, weight 233 grams; left ventricle in svstole, right in 
diastole and containing a considerable (juantity of fluid bl<K)d. Myocardium of 
normal thirknrss, c(»lor. and consistency; not friable. Mitral orifice of normal 
size, comjK'teiit to wabT lest: valves normal: first 2 inches of aorta show 
lu'ginning calcareous cliangfs: coronary arteries ]»atent: bicus|)id orifice and 
valv«'s normal: right auricle contains chicken-fat ("lot. Left jdeura shows a few 
adhe>ions to bast^ and ai)ex of lung: otherwisi^ normal. Left lung weighs 915 
grams: lowj-r lobe crepitates; upjier feels hard and nodular: upper lobe floats: 
ajM'x shows tw« small (cavities filhnl with tubercular debris; rest of lobe riiowa 
num*'rons luKlular. tulK;rcular fo<*i, and sonn? serum exudes: lower lobe on cut 
s<'ction has bright-re<l appearance and is very rough, showing innumerable miliary 
tul>ercles. Right lung weighs 7'i^t grams, floats and (rrt^pitates; external aurftu'e 
f*M'ls shotty: a]>ex shows, on cut s"<*tion, tulx'rcle in advanced caseation; all lobes 
sh(>w diffuse miliary tul Mercies, and serum exudes from cut surfaces. BroDchial 
glands mnch enlarged and show jKlvanccHl tuln'rcular degtmeration, with oonaid- 



IIAKINK-1I«»SPITAI. >KKV|rK. \>'^ 

imrva^ii* «|r|awiiii I tiii«-ntuiii iMlhf'D'Mt (<• |ii*nt«iii*'iitii ami iiit«-«iiii« •* iiml 
• "Ct«:«'«ii«1 siili'fii ulitfhtly ••iiljinriil . wi-i^h** .'.''i Knim^: riit ?M*4-tViii 
rur •••ni;r«f fici imlp frMl>l«*. Ui»;lit kulip y w^ u'li« ,'!*« k'r;iii>: lurj^f. 
llArkiti«r* fairl« i1i«tiiM't. imii'li «**iiii;i '«!•'• I: t Mitt-x hip •%%'•« >illiiwi»h iin-it**; 
^r^l hnu. ARii ft<»-|« rilir>'ii« l^i'fi kidip y wi'i;;h« .''i? irniiii**: ra]H.uli* 
'tat. Kt^mik f'iiithiii;« m* in thi* rt;;ht llhuMiT < ••ii!ait.i'«l aUnit *Uni i*. r. nf 
^. miii •<«ui in«^iiliruii>' imniiiil |N*nriii«-nrii M:iiiy Mt|lif*tiiiii*i N'twifii 
J vuivra |mti*ffH-iiiii ••% I'M whf-n- il •tttil with miliary I iiU'nlf^. Ihm- 
<iiiaI (>ntitff< t*f kmII ilm t« i^ut* lit Stuni.iih n ri:..il .li'jiitiiitii iinil 
^mAlU o*n«;*'*:r«| ■•.v«ri'*l witli miliary inUn h— ;tn-l :i<ni*T«'nt tn Mir- 
lM*Qr« InTf TfuftlU . ji'jiitiiiiii ith«iw<« twii tir thn-i iili ••n>. with « N'VhIihI 
I tlv].f«-w««! i-«ii!ir* .iii*l *'( .tUiiit il I iiiin. iliaiiii-T'-r IKiim i-i<iitaiiiM 
rwf^ tii>'r- huiii*-riiii!> •■•iHt'tall> iit'ar thf ihti-* .1 • til \ai\i*. wliffi* thi*y 
mr\\ Vi" wh .!•' l«itii*-ii I'li-iTo varv fr«'iii .: .' !•• l.V* mm in Miaiih-ttT: 

m 

i^itrr *i '.if^ r'lti* .!« a rul*- tr.iii**%ir«M'ly with th< kT'it: thi-\ ari'imn- 

li*^ • 1 r. jir« *> ;it<i .1 f. w -iiiiilar iil'»-r-. •■x!«rti.il -«irfji« vi-ri-*! 

mry tn^«7l«» l.;\'r •iil.irt^-*!. Wfifcrht 'J.l'Mt t;r:iiii«. «>\TfriiaI xMrfaif 
nth miiiAfi tnU-ri !• * • iit« hanl; > iit •Mt'tiiiii hit- \*'r\* Vfllnwi-h riiltir. 
kl«ati<««l 1a*.'.\ ■h'lcriifratiofi l*aTi> P-a*! ii«>niial 

.1 M K 
a. \v. s. 

^ •"■ riAtniTy Niirwa> a«lmiM««l !.• t)ii I 'iiiii •! >*at»-» Mann*- ll«»-*jiital. 
• M ! N-»i«'IiiUt -*.J. !*.•■• 'nirj-'irri •! Jr-iM ?L« rtiiT.tl Mati*-* Mariiu* 
N". rf..'.V \ I >li<-<| N'lv niU-r ."<. l'*"'. at ".'•''] m 
Aikf •<'v K^th'T iiii«l in'*f l:-r •|t*n<l. ■Mti'M- xf •} t'h :;ikn>*Mii. tw.i hr«ith- 
r«- •i*i*-r«. «J1 iMint; lUiil wi-11. 

U kft J ll.»'l mM thf •ll'«-aw- tha* afi- ii-'i.i'.. . .;. ;>liiiT ?•• • hiMlii»"1. 
1*1 .«i.- yrjur afcT'i ;»tiii'ral ln-.il'h ,;'--l .:\'* v. ■.•.-?•. r\ ..f v.-m-nal 

i kiBt'-ry — Ataint «■?!•• Vfjirab.'" j».i*»»!i* '!•■%• '.•■;» 'i . I ■■■■'1^1:. :aih«r ini]>l 
»■!>• :n « li<kriti~t«<r iitt«-n<l<^l ti\ -li^h' • \]*- * : t*: ii wt.i. :. w.!-* •« 1 a-i<iii 
•I «nth hl'Bal. ('••Uifh ura'liuilii i!i» r- a-*-! i»i ^\.r:!^ l-i-jiT iii'-ii- j-r*- 
in lh«- luxniinir*. alnl a««'«'lari'«l \%i*h fr** ,m* f* ihllly -•■M<>a!:<iii- ami 
■^aS« A« th** i'<<iil:ii iiiin.i««>l ;h<ri \^ i* a jrnlM.il ih- liT:i' in )f*\\ 
wm\ «!r*iii;1h A)»iii! tM<< iii'-iith<i nj » '■-..'. i-i aiii<- ;;r .iM . • \ 1^' 
■ij»<i.rr»ti«.n \«r> pritfu^- \Vh> u .flu: "• -1 • ■ ?!•• \> ■; :' il N Mi?i»»r 
,ii}«i- a\ • ialiilt.a*'.>.ii t-liiitiil all M.<- • \. ira- '• r:-' • -'..n^ .ii.'l -. .; '••iiix 
IV l'}>«-r> i:l««l« ■•f lh«- lnti*'«». .ili'l tin- ill »•:!..-■.* .■• H •-» . Ti.]:!'...!! W.is 
I irf'.h*-! l»\ a lit:> r'*---'!'}' • \al!i:ttati u ■ f •• -•.■■."»«;.. w';lili r«\»a!'il 
fi.» • t lU r I- »..ii llli |'a!-.i: .|'..l \\.lii'-r .- :•■"'. a! ! 1 I "i 

in 
uf ti^.f. /■••■If • ii/f. ■ -I. iff. K\ti 11..1I a;-}" araf.i • \I»*iniiii ••i/*' 

f ■• I 7 irji ji- * k'* II* r il !.■'::•.; 11. rr ;•-!. ;«-!li. r*» i i h\i'l:'\ in .ill 
1 ;Ar^> ripT-r •:!••:• ■• Ht !i :: a- • •! \- .;•;!- •ii'i*' ■! a! ■! ■ -I't.i!. *''*.* ",' i%'r\ 
N rti jiflia'. i^»t' • •■ii*Air.< •! ]'-**% t ••f*tri'k\ ■' ii-^l t!-::-! T'l-- •■•i«l-!l.' Ijal 

iMi » *• ri^l )i\ a — !•• iili! jn"'»'» • \'i-l i'» .* \.: '» I .1 I '.ii-l' r«' m-- ;• ir' ; il 

i»-f. l.*.»- iii«>« jir>l:uiii wa- ill- \« rf.| \>\ .ii> • xri-ia**' • ' .1 • tii." ir ii r-i?- 

tt» r*- 'S-ti**- nlir"U« ImU'I' *» • r«* ■•K-M I ■. • •! ! . ;. !-• In* « 1 1 • • ■ {« r ■. .^ •i^iiiii 
tXA% • «"'.lfiiii !■ ii>«; t^iMiiaT^ |<r'-ts..i • :.' .r (!.*• )<a^< ' ' • ■ i ' t*.>l 
tT::^a«l t'."- fri"»- lii'\iiii<iiT I'f that ••: „•.!■. I!.- -.i- •.*.!• ".: !•■ •■ iii 
•fvl •■*. lh.- It •! •i.lf u.i-« ailli' It '1* t.i ! .f .-.:..■ II'. i:? \V •!.•.• I » .'•• 
i^chtl • 'Isljt'ral • .1% ff •! !■% a -M r-> *tt<t II.- n-* • 1 . ! i!> a- .1)" -^ -* 1' -! ■ 't* 
im rt.^. r^^*\ ( Il M« ti'-ti l!.i \ .i!« • « \«< r> ?•■ i.-l ■ ■!.;••■;• .ir ■. 'I • In 
•- ••«•-?•■ ?!• Ill t^l »Il»:lif \i,;' !a'i* i •!■;-. -J" :.'•••• ;_•!.' !,•...•. I 

ft^rdi»«S •iikAlI aii!i-lii>irli-iii i ! -' IC:. !■? \-'*- .• •\ t' ! a'-lfi^!>-I 'a .a 
h • ) <* A -ft.* rhiirai \* 1%*. I .i*»i -i:.:' t I. - II . K- - ;■ • 1' ' • t _ t!-- 
fli.^J i»r*i I Wa« •■♦ph i\til ». »■■ s'. .» • I'i .r • I ' ?! : t: . 

fc"- * ♦■• • ' !lj«' lull' •ii<t III! iiihr. lilt 1 1 • . ■! !.. •• .i" .! T ■ ■ :• .i* ! 

•lir w a» 1 • arr«t l,i-.»r » hi- aMa- I.IM- i.* ! !'.- \ - i". ■ '.■.•■ 

«^« I 'ir If4« hi-<« afi-l ' f ill ):\.i\ ■•.»■ -Jilt •■•i-l I I • 

bv lar^iii t.liti^*- 1^ M H<;.li<I ....•ii-.- .| - .• 

v*ll .ati't I'i th' ihal'hr i.-ii. at •! h. • M 1 • . fr,- )•• • •!• • 

W^r tl^f ««ll«l-«|iffi« It W 1^ I • • I --•!! \ ! . i I i • »•• • I ■ 1 • ! ■ • ' • 

aJ I N( ■»« fi«i|| M \ri il •iii.iil I a\ iVi - v% ?• '•>• I \ • I ' w • .1 . r 

•imI •ifiuittil I.- .!• O i|> \ • • !»• ■ a'- •■• ■' ' Hi 111 



176 MARINE-HOSPITAL SERVICE. 

'"February i*(), — After rei)eated examiuatious tulwrcle liacilli fonnd. Temijora- 
ture had ranged from 37 to 8H.5. 

* • Ma rch J, — Discharged improved. Readmitted for tubc»rcle. 

'"March 3. — Examination shows on inspection: Ex^iansion of chest fairly good, 
right lK>tter. Palpation — vocal fremitus normal. Percussion — slight dullness of 
left lung i)osteriorly at base. Auscultation: Respiratory sound exaggerated over 
right chest, suppresae<l over left lung posteriorly at base; vocal resonance dimin- 
ished over loft lung at base T)osteriorly. 

''March 4. — Some swelling of right epididynais. 

"March 10. — »S welling of epididymis and testicle continues: now decided enlarge- 
ment; quite painful. 

"'March i.T. — Swelling 8om<*what incre^ased in size and more painful: x)ain is also 
Iirolonged along cord. 

"March VJ. — Pain and swelling less marke<l. Patient weighs 163 pounds. 

"March J:i. — Passed two or tliroo yellowish lK)dies, the size of a pea, ])y nrethift. 
Aspiration with h\i>odermi(r over fluc^tuating iK)int gives a small amount of Moody 
effusion, but no tulK^rde bacilli found in it. 

March J7, — Abscess pointing at upper end of testicle oi)ened and about lOc.cof 
pus obtained. 

"March ;J<s. — Tubercle ba(;illi found in pus from testicle. 

"April 1. — Testicle remains enlarged and pus is discharged from sinus in tes- 
ticle. 

''April !/. — Testicle removed (chloroform aiuesthesia). Pus and caseouA mate- 
rial found in epididymis: t^^sticular sulwtance riddled with tuberclt^. Game 
drsiin inserte<l. 

"Ai)ril ^'u. — There has been some discharge of i)us, but the wound is now gran- 
ulating ni<-t ly. 

''April on, — Is still troubleil with deficient hearing and discharge from left ear. 

"May 7. — Patient is well nourished; coughs but little: temperature has been 
normal for several weeks. 

J. M. G. ' 

Condition when admitted to the sanitarium was as follows: 

JftncJf!. — Physical examination: Inspection shows full chest, typical nails and 
gums, movements of chest even, skin in good condition. Palpation — vocal frenh 
tus nearly al)sent in bases of botli lungs to alwve level of nipples. Perctiasioii' 
no iM)sitive dullness can be demonstrated in left ajx'x, as clinical sbe.^t fr iinSan 
Francisco mentions; marked dullness in bases of lK)th lungs to about level of n^ 
pies. Auscultation — vesicular murmur very faint in lower half of each Inngt 
anterior; iKwteriorly, bronchial breathing at base of right and cogwheel respfaB- 
tion at Ikiso of left; roughened breathing in the other ]X)rtion of both lungs; hest 
apparently normal in all n.siwcts. 

From the very sbirt this patient complained of severe and persistent headaobn 
(fnmtal), wliich later on bec^sime general. He was always dull and stnpid and 
incline<l to be filthy in his habits, and he probably swallowed the spntmn froB 
time to time. On July 21 examination was made of left ear, and it wasfomid 
that the eardrum hiul Ikh^h pre\iously destroyed. The headache at this time mi 
very s(>vere, and careful watch was kept over the mastoids, thinldng that ttt 
heiKlachcs might 1 ;e caus(*d from mastoid disease. On July 24. after seveiral cbBk, 
with high temi)erature. he was found to have a hirg(» tulwrcular pnenmonia nt ttt 
base of the left lung. This <•( >udition seemed t) grow worse. On August 23 tdbai^ 
cular pnemnonia develoix'd in base of right lung. At this time the man becsHW 
very sick: was delirious ami hard toc(mtrol; did notresjiond to stimulation. TtB 
f(»ver gradually siibside<l and the temprratun* nm subnormal to the dayof Ui 
death. Died from exhaustion. 

\rcropsy (ri(/hfnii hanrs afhr death). — Rigor mortis marked; body wellnom^ 
ished; no scars except in scDtuiii, showing where testicle had been removad al 
])revif)us f»p«;ration. The cal varium was removed, and the dura was foundadlienBl 
ill several ])laces, esiMM;ially along tlio longitudinal sinus. Near the siniiswaM 
abs<ess<*s which were cut into, but unfortunately none of the pus was securedte 
micro.^'copical e.xauiinalioii. Near the longitudinal sinus the dura was llV 
adherent to the arachnoid, and the ar:u*hnoid and pia were firmly bound dowato 
the brain tlirougliout. The ara<!hTioid was enormously distended with a dflW 
white seruKi which contiiined a few rto<'(Mili. The blood vessels of the brAinmit 
distended to such an extent that it must have caused a certain amoontof ooii^ 
pression. It was not ice<l that the spinal canal w<is also greatly distended trtt 
this clear fiuid. On turning the brain out and severing the spinal coard MBie c( 
the fiuid was (rollfH^ted on slides for micn>scopical oxammation. In aeotiott of^ 



J 



I • 

I 



M V » 



: • - ■ . i ■ . - . . 



178 MARINE-HOSPITAL SERVICE. 

bod, and thero he remained till hedie<l from sheer exhaustion on the 16th of Novel* 
IxT at 8 p. m. 

yrcrojKSff {twrlrc and a half hourn after death). — Shows the body of a poorly 
devclopctl, poorly nonrished, adult, white male, alxnit 1.0 meters higti and weigh- 
ing 47 kilograms. Rigor nu)rtiH hua entirely di«a])peared in the ui)i)er limbs and 
is very sliglit in the nether limbs. Hypostasis is very slight. A few 8car». circular 
or oval in shape, are present over ejich knee. No fwlema is present. The sabcnta- 
iieous fat is almost entirely absent, the small amount present being very dark in 
<*ol()r. The superlicial lymphatic glands are not enlarged, with the excreption of 
the two hii'hest anterior cervicals. The aMominal cavity containH about 1.(KW 
V. V. of clear strous lluid. The omentum is almost devoid of fat, but is otherwiftf 
normal. Tlie ant< ri< >r mediastinum is normal, except that it contains a few tuber- 
cular glands. The i)eri(rardial cavity ccmtains al)out 50 c. c. of clear serous fluid, 
but is otherwise nonnal. The right pleural cavity is entirely obliterated by 
stringy adhesions. These are esiK?cially dense and firm over the right ai)ex. The 
left i)leural cavity is almost in the same condition, except that the apex of the lung 
is almo:.t entirely froe of adhesions. Tlie right lung can not be removed becanae 
of the dense, firm adhesions which Innd it to the tlioracic wall. Its surface is 
ncxlular >vith tul)ercles. The aj^ex is entirely const didated, and on sec^tion is found 
to contain a large sinuous caWty , whi<-h is filled with a greenish creamy pus. The 
left lung weighs liM) grams. Its apex is almost entirely consolidated, as is alao 
its base anteriorly. Posteriorly it is (*rei)itant and emphysematous. The bron- 
chial glands are enlarged. The cut surf at -e is studded with tubercles, some 
8h<.)wing ixTijiheric masses of pigment^'d scar tissue. The tendency to breakiiMC 
down is more marked at the center of the lung than at the base. The heart 
weighs VM) grams. It is small and pale and shows on the anterior surface of ito 
IM'ricardium an irregular white milk spot 5 cm. in diameter. Its apex is made 
up c'utirely of the left ventricle. The aorta is small and elastic and shows a few 
thickened*sTH>ts on its intima. The left ventricle contains one lardaceons clot 
Its muscle U pale and flabby. The aortic valves are normal, as are also the mitral. 
exc<'])t that they show a few patches of sclerotic thickening. The right ventricle 
is thin and flabby and contains also one lardaceons clot. The pulmonic and tri- 
cuspid valves are nc >i*mal. The right auricle is slightly dilated. The liver weigltf 
1 ,250 grams It is small in size. Its outer surf ac^e presents nothing abnormal. Its 
cut surface shows th<> center of the liver lobules to be somewhat depressed and 
puqde in color. The ])ancreas is normal. Thtj sjileen weighs 150 grains. Its 
outer surface i)resents no abnormality except a few white thickened sjiots on the 
capsule. Its dimensions are 1IJ.2 cm. long by M.3 em. wide by 3,8 cm. thick. Its 
ccmsistenrvis normal. Its cut surfiu'e is dark reddish-gray in color. The trabeC' 
ulje and ^f alpigliian 1 )odies are qui te distinct. The right kidney weighs 175 grama. 
It isquit^' sTiiall. Peri nephritic fat is almost entirely wanting. The capsnle is 
very iwlhiavnt over its anterior i)ortion. The outer surfacio is pale ana fairiy 
sni(K)th. A small st*'llate depression, red at th«: bottom, is seen on its iwivex 




outer surface? is very finely granular: otherwise it is similar in all respects toiti 
fellow. The stomach is small. Its mucous membrane is pale. There are some 
adhesions iM'tween this organ and the transverse colon. The intestines aremout 
and almost coUapsfMl. Their mucosa is dotted with shallow o\-ad ulcers, whose 
long diameter runs i)arallel to the transverse diameter of the l)owel. The mesen- 
tx'ric glands are enlarged and caseated. The dura and pia maters are normal. 
The? subpial fluid, however, is very excessive in amount and elevates the pia mater 
considerably from the surface of tlie brain. Tlie fluid is clear and serous. The 
brain we igl IS I.-IOO irrams. Its cut surl'ace is si ii^htly (edematous, but otherwine 
shows no }']>nonnality. The cjiuse of death i** exhaustion incident upon tubercle 
of the lung and the l)owel. 

M. E, I. 

J. M. O. 

.V/'T/wi'i>y,/i' /•♦7>o/7,— Lung: The si)ecinien is almost entirely consolidated and 
consists of illy defined netTotic^ areas, witli ]»eriplu?ric masses of lymphocytes a id 
epithelioid cells, (iiant (^ells are ])res«nt,l>ut not in very large numbers. The 
surrounding lung is h^^)erJemic. Liver: Upon examination with the low iiower 
obji'ctivt?. the center of ejich lolnile jiresents a brown ai)pearance. More xninnte 
examination shows this to ]n> due to the fiwt that tht; cells in the (*enter of the 
lobules are filled with fine, brown granular pigment: otherwise the liver is 




VABIKK-H«JHI*ITAL HKKVirK. \7\^ 

KklBfy: At n^fcnUr ini«'n-ii1« U'ritHth tSi-rjiiMiili* nn- 
In '*^h tht* tiit4«nitituil ointi*i'tivi' Ti!h««iif< ih hyiHTtrnpliii* 
» t«h«li« •trnphir. twrrti Ihnw* arpaii thi* lnhiil* <• iip* li»r^«* aiitl a;i|iiir- 

likilnl iMit nchmriap BcimuU. Thf r*-iiiJiiiiiii»r iMin-iiiliyiiiH iirf^-iits lu* 
nbty Htfffv and tlit-n* imc* mar w*^ n iliUtinl tniiiilf nr a •>iu:%\\ «■% -t cnn- 

<««tf«lato4 flaiil. mad bm* aihi tbfn* n tiifiiil iiTaiiiiriK a hyalim* ta*«t. 

iMsklMi lHHUi« Affv Mwdl ami nhmnliiti fruiii tliM:r ra|*iili* sjili^'it: ( 'a;»- 
nl^ tlUck mad iho». tdtwrwii^* imniial Tia)>-<-iil:i* in Iikf i-i>iiiliti m. 
Mm hriHIiiB an* ln«|pilar in imtliiw* ami vhm* ly |in4-k«-il. Ttii- Malio»rhmii 
I ikiw a tbti-kFBliiff of th«* Intima. Pulp i*« h>iH*r.i-ini< Tin* r<*lU an- 

l ynA i«?v luwl »|*lrm n*llii. Ki)mi)>la-T« ]ila*iiia i-i'IU ami ]«»I>iiiiir- 
iMff« ar^ cN4B|ianilivff>ly frw. In ih** |>nl|i tlii-n* iii.i> l^' •>«•• n a ffw NinaU 
r ana> •nmiciiiilr«l Iit a K»nf nf IvinphtM vti?* an'l •-i*ir}ii'!i«<i«1 i-»'ll- No 
rib aff^ Twililr. 

M i:. I. 

.1 M <■ 

ac». II. nalirity. KiK«tt. iiilnntt*-*! t.- I'r"\ •!• ii< • II<>*|iit;il St-.ttr]* . 

^y l'ati«<«t •tali-il that lhn«* Wi-v-k** |inv)i*ii*l\ !:• IlmI falp n li'UH a 
ly al whirh tini*' lir riivrifm f-cl a M-vt-ri* \kxu\ \u I- fr •*ii|«' nvi r )>i\\< r ] .tri 
L Thw |«tn man ntill |in-M riT wl.i-i> apphi atinn u.f* nuwli- f<r trt\t;iiit rf. 

t4 tbr c)r«ptiii*a «ifi • tfriMii VM r> t)i< ••nly thini:- ^f wlni ti I nipliiif*!. 

^VfwCanQtaK him ht* ailtiiill*'«l Miat fi<r Thr*-*- ni"iitl.- ]•?••% mii« f- hi- f.ill !>•■ 
Ftt tr«l4ri| mmh with a riitiirli 

fetnatk*! ftbowt^l thr )«!:« nt t<> )«• r«>nii'w)iat • lu.ii latt-il .ifi^l •|tiiti wi-ak. 
wmm taiiii><k4litT tif \\v»* It ft »:•!• ff • hf-t. with ••^nr«ratii«ti Kf tht- inlt-ri-ictal 

tW l*r««th Minn«!« ••%■ r th.« •I'h' wi-ri- ahii<»T ■f|.lM•ll^'• T.t< t:li- fp-niitu^ 
mt Af**! \w-m\ i'f ht-urt %^a- i!i»]ihii • i1 t<> tt.> i:." * i-f -r< riiiiin. ]• n u- 
rft1#«t a t}tii{Anit;i n *i<i.Hiii •■ . i« r • ii* rt- !• '• -:•'.• • ' . N -.? tin- • i-:;. >■ t ■! 
ra«~t«niiti« th^ri \<*r* !;•• •xiil't'-'-if rl.t ; •. - ij« ■■ i'f Mu-I \\!.«n 
Ihr h«*iiital. liiit lk:i« h:r>iiliia!l> a* ■ i:ii:iii.itt«l w h> n ••ip i-ii-^o' ;: {>r • 
i| T^ry Iikf that hfanl whfii a •!<■*•«! • .iik • ••nlain:;..: li'iT .. - .I'.l 
ty nf 0iit«1 u Bhakin. Kiaiiiniati<in *•*. nu'hT Imt k' •'li'-wi*! 'iiUr>f.'.ir 
^aFttt <tf thr a|« t T« ni{«*ratiir«- i-n aili!ti--:< t. u ,i<* ::rt. .' < ' ]>t/.- i i< .n. I 
llitt 1" affl at n • t:iiii* iliinn^ f }ii- I ••iir«« ■•?•!.• .l.-M-a-M \\..-.r*.' r.i; ■!:•.• ' 
tkift niTi h :i.« riiM>«-«! lluri-wa- .il'^- .i*. .i ii. •«! i-< i:;; '.• '• .in i -*) • -m ••* 
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vet «*^«iit)|iti4iiatit ami •'itiinl.iM' ii .mil .i-{>:r.i*:- ■^ \\« 7> r\viit{>-rf rt •«). 
r if fr»-th% •iTiU'ijr .!• ft f'.nitl l^-itik: uifL.l'.iw!. « •*. ut U 'h fi! • . !*.• 

ar«! li^lh titi i hai)i;« in t).'- !iii:i«tt.ri ii'i.il t\ -f !^f {» r< u«.«'."Ti > ini<l 
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aail ^^r% p-'f!) li'itiri-'hi'l \-^t i!.i>r1>ii. ?'..v-I' . %r \ ■!»-.. r.i*: • .«.••■. 
t*|a<i t.«a-ti|iiK !**•• • htpl a Uri.*'- n'iai.!:!\ ■ * '• i! .»•«-.•;• -1 *• i i f ■ *• 

cm«iiy Irfi liiri^ war* 1 ••iii|ir«-«<>«'«l ii.t '.»>•'. I i ..k .».' t:i.>* *■ • . ! 

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la iLv fipirr l-*l«< « till ti •••iiiiii'ii. !•.»!• •! %%*!.■'• ; ;• r.i: • i^.* 1 

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Aft ■^lafHltlHll'^* i«f ■|<*il<itit -l> M ■ ' . > * Kfe> :lli { I • «« :.' 






180 MARINK-HOSPITAL SERVICE. 

ance; toward tho clost^ thero was diarrlioa of a very severe chjiracrter. The dis- 
ease followf(l th(i usual conrHt'. and the i)atieiit dieil from absorption of toxic 
products and oxhaustion. 

yr('ro})sy ( eitjh torn houra after (hath ) . — Grejatly emaciated: rigor mortis marked: 
ellx)W, kiiee, hii), and vetebral joints aukylosod from rhenmatism. Weijjht of 
heart, 275 gmms: valves, cavities and walls* apparently normal. Left lung bound 
down around ai)ex and ]K>st(^ri()rly by adliosions: anterior surface of right Inn^ 
very closely bound to thoracic wall by denser adhesiims: weight of InngH, left, ftw 
grams: of right. 1.07.") grama. In apex of right lung there was a ca^-ity of abnit 
12.") c. c. capiu^ity: ui>iK'r. middle, and lower lol)e8 infiltrut^Ml by tnliercle; inHt 
lung oidy a small portion of diaphragmatic surfac*» was free from tulien-le: 
remainder contained cheesy masses. Liver normal: weight, 1 .675 grains. Splttn 
normal: weight. i.'7() grams. Right kidney normal: weight, 160 grrams: left 
kidney nonual: wei;?ht, ISO grams. Stoma<'h normal. Pancreas normal. Small 
and large intestinos normal and emi)ty ; mesenteric glands indurated and enlarged. 
Brain was normal; weight, 1.150 grams. 

F.I. 
Milianj t uhrvvuloaiit, 

J. N.: age, 38 years: nativity. Ireland: admitte<ltothomarinewanlof St.3Jam 
Hospital, Milwaukee, Wis.. October lU): died Noveml)er 9, 1900. 

llistortf. — Patient has had syphilis and one or two attacks of inilainuiator>* rhen- 
msitism, the hist o<-curring in the beginning of the pnjsentyear. Abont thrwyeaw 
ago h(» suffered frran a severe attiic^k of i)l«»urisy of the right side. Present iflue* 
iK'gun two we<'ks before admission, and was marked by severe ]^)aln in both tern- 
l)onil regions with rigors, sweating, and jirostratinn. Auscultation over the chest 
disclos<*d a blowing systolic munnur heard most distinctly over the apex and in 
the axilla. The pulse during his illness ranged frnm 50 t^) 56 i^er minute. The 
tt'nipcrature, which was at first normal in the morning, bec*ame oontinuons on 
the third day and ranged from oX to 89 C. There were at this time short i)eriod.<i 
of mental dullness or helxttud(\ which later l>e<'ame deliriimi with Cf>nstant iniL*- 
cular movements. Under the influence of bnmiides and phenacetiu the cepha- 
lalgia erased to botluT after the second day, but the jiatient graduaUy sank into a 
state of coma, from which he never rallie(\. Meningitis of some form was earily 
diagnosf»<l after the second day, but of what nature, as regards the causative 
factor, was not fully determined. , 

Xf'croj)sff (cifjht /H)urs aftrr (h'dth). — Brnly of a muscular man fairly well-nonr- 
islnMl. Rigor m( )rtis not marke<l. Brain : App'arancres everywhere seemed nomuil 
stive on the inner aspect of t]i(» dural mi*mbrano in both temporal regions. Here 
werr to l»e seen xjatcnes of minut;* elevations somewhat smaller than a millet seed, 
white in color, and disposed evenly over th«^ surface. Degenerative changes, aw 
shown by yellow disc»donitions. could not be detected by the unaided eye. A con- 
siderable quantity of serum was frmnd on the base of the brain, some of it being 
in the lateral ventricles. Brain weighed 1.1^0 grams. Thorax: Heart pale wd 
an {em ic, size of tho fist: an old fibrous i>atch showed over the right ventricle: 
valv«'s are comi)eti'nt. Organ weighed 2oo grams. The left lung was adherent 
to the thora<*ic wall at the ajK'x by old adhesions. There is a s<.>ft caseous tubercle 
in th<' apex and a hard, gritty . calcareous one on the anterior .surface of the middle 
l<>b(?. This lung weighed 4;{o grams. ( )n the right side the lung is bound in itB 
containing cavity throughout most of its extent by adhesions. jS> firm and dense 
are th«*se tliat ])i»»(v8 of tlie lung substance* are pulled away with them. There are 
six or more caseous tnlMTcles in ;>s many situations: one or two are bec:oming cav- 
ernous: hy])ostatic congestion jit the base: weight. 450 grams. Abdominal vis- 
cera normal. 

R.B. 

Tiihrrt'lc — nnmc/Kt-jtmuiHoniti — l*lciirixij^ chronic, 

(). ^I.: Mg<\ J? years: nativity. Sweden; was admitted to the United States 
Marine IIos]>it;il. port of San Francisco. Cal.. Novemlx^r 17. and died November 
*J1, 11K)0, at9.:r>ii. m. 

///Wo/'//.— Patit'ut complained of i)ain in left side of the chest, accompanied 
with cough ami copious «'xi><*ctoration. Had been in ill-health for over two yeaxB. 
and had h»st 10 kilograms during the la><t two months. He had been too weak to 
pcrfonn his regular work for som«» time past. His appetite had been very jxxyr for 
a long time: Iniwels n'gular. Physical examination — lungs: Dullness over both 
airices. on iMT<-u.Hsion: on ]>iilpation, vocal fremitus was greater over the tight 
apex; auscultiition, bronchial breathing and moist rales over the light apas; 



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k ■ . 



182 MARINE-HOSPITAL 8EEVICE. 

1,650 prams; conK^fttod at base, with 120 c. c. of clear thin serons flnid. On flec- 
tion the hniiu appears normal with the cxc^fption that the ventricles contain an 
abnormal amount of fluid (iJOc. <•.) and the vo\or of the cerel>ellnin is darker 
than usual. Sx)inal t'ord slightly couKested and surrounded by abnormal amount 
of fluid in tht; subarachnoid HX)ace. Several adhesions exist between the piamater 
and duramater at the vertex of the cerebrum. 

G. J. S. 

J. M. G. 

Tuhf'rrulosis, fimff viilutry. 

P. McG.: ago, 82: nativitv. New York; admitted to United States Marine Hos- 
pital, Stapleton, Staten Island, November 26, 1»00; died November 28, 1900. 

Fuwfiy histori/. — Father living and in good health; mother died iu childbirth. 
Four sisters died of cholera. One brother was paralyzed, one died of pnenmonia. 

J*(tst hintitry. — Indefinite. Patient in a very weak condition and was not qiif«- 
tii>ned closely as to condition of health previous to present illness. Drinks consid- 
erable. Stiid ho was always well until the beginning of this month. 

Prtsi'vt history. — Dates his i)resent conditi(m from November 8 of this year, 
when he was drinking to excess. Remained on a spree for several days. Appetite 
wj:sp(M)r; nauseated, especiidly in morning. Nervous, couldn't sleep; complained 
of XKiin in alxlomen and diarrhea. Condition rapidly became worse and he entered 
hospital. On admission complained of nausea, anorexia, diarrhea, jjaina in abdo- 
men, and weakness. 

E.rtt mi nation. — Inspection: General appearance poor; emaciated; anspmic: 
sordes on teeth and lii)s; tongue coatecl heavily, dry and cracked. Clavicle:^ 
prominent; expansion poor, abdomen flat. Palpation: Fremitus increased over 
apices of b<»th lungs, especially right. Tenderness over large intestines, especially 
over descending colon. Gurgling in right iliac region. Liver felt below ribs. 
Percrussion: Dullness over apices. Auscultation: Blowing breathin;!^ over both 
apices; snlKTei)itant and fine mucous rales over rest of lungs. TemperatUTP 
slightly elevated: puls<* H8: respiration .'JO. Has cough, with mnco-pamleDt 
exi)ectoration. 

Tri'otnu'ut. — Milk diet, salol. lea<l,and opium pills. 

Nort'nilur J?, luon. — General condition worse: passed a poor night: boweb 
moved fifti»en or twenty times; movements fluid in consistency, ycdlowi^ color, 
and hir^e in amount. Temi)erature in morning 37.4; respiration 80; pnlseW. 
Slight cough, with muco-purulent expeittoration in small quantity; pain in abdo- 
men: wealcness i)rc>found. Diarrhea continuecl unchecked; general condition 
about the same. 

ynrrmhrr ..'.v. — Passed a \xx)r night; 8oile<l Ix^d several times; diarrhea pendst«: 
movements li(|uid. light brown in color, and amount about 1 qnart with each 
evacuation: has hectic flush; tongue coated: very little appetite. Temperatnre. 
:{H.(S: pnlsc rapid: res]iirations shallow; alxlomen markedly tympanitic; pain 
along colon severe: tenderness over intestines: coughs but little, and not mnch 
exiMvtoration. llt^ says milk causes cram|)-like -psdus in the stomach; stimnlatiDn 
l>n»siribed. Found unconscious by nurse shortly after morning sick c«ll, and he 
died at 11.20 a. m. 

AV trnfisy ( twenty-four lionrn offer death). — Body of a male, apparently 40 yean 
ohl: small stature, muscles ] KM »rly develoi)ed: amount of sulx:ntaneous fat small: 
rigor mortis marked: suggillations in dependent parts of bcKly. Anterior medi- 
astinum nonnal. Remains of thymus gland not found. Pericardium in normal 
]>osition: amount of fluid in ]M>ricardial sac,alK>ut5()c.('.; iM*rica^dial walls nonnal. 
Ib'art in normal ])osition, weight 2:^*{ grams; left ventricle in svstxile, right in 
diastole jmd containing a <"onsiderable (|uantity of fluid bhKid. Myocardinm of 
normal tliickness, color, and crmsistency: not friable. Mitral orifi(*e of normal 
size, crmipetent to wab-r test: valves normal: first *J indies of aorta show 
beginning <*alcareons changes; coronary arteries i)atent: bicuspid orifice md 
valves nnrmal: right auricle contains chick<'n-fat clot. Left pleura shows a few 
adhesions \i\ ba^? and ain^x of lung; other\\i8<' nc^nnal. Li»ft lung weighs 915 
grams: low«r li>be crepitates; u]iper feels hard and no<lular; upper lobe floats: 
apex shows tw« small cavities filhsl with tul)ercular debris; rest of lobe ahoWM 
nunnTous niwlular, tulMTcular foc^i, and srnne senmi exudes; lower lobe on cnt 
secti<ni has l)right-rMapi)earance and isvery rough, showing innumerable miUary 
tulK'nrles. Right lung weighs IW'i grams, floats and crepitates; external aurfoce 
feels shotty: \\\h*\ shows, on cut section, tulM*rcle in advanctnl caseation; all lobes 
show ditfuse miliary tuln'rirles. and serum exudes from cut surfaces. Branchial 
glands much enlarged and show s^lvanced tuln^rcular degeneration, with oomid- 



VAKINKMI«»KriTAI. sKKVirK. \y^l\ 

n4ki ilr|B»itji < Hiit*fitiini iMlhf*n*iit (<• |H*ntiiiifiiiii »iiil iiitf-:iiit« mihI 
■HP ■ti^f S|i|i^ii vhiclitly •■iiliirtfiil. Wfit;h«i ?'.**i Kriiiiifi. i nt •••• ti<iii 
r«4ii{r«iii<i. lHil|i frkiMf. |{it;)it kiilti* \ wi-u'tiw .'l*« k'r.iiKH. Urk'*'. 
'ki&ir« fairlv tlutttitt. tiini-h r*iiik'*'«tt<i|; ■ •■rtt\ i^lf •%%-•• >i'II>iwi-h iinitn. 
I. ftm. Ami fff^U Mtir>*ii« l«ffi kidiit-y wi'i;;ht :'*' tcmiii*. i :i|Miilt« 
. irfwi AmlitiAr* »• in lh«* ri;;ht |tlu<l'li-r i ••ittnii.i •! iil-mt •'•'■i i- i-. nf 
■im^iQ* tn^iitiruiH* iitimml l*iTit«iiit-nin Miiii> iftilh«-«t<iii« )»-tWf<i'ti 
M-vrm. iM*nt*iCifiiiii f\fr\ wtH-n- «1 ittttl w ith iiiili.irv tuU-n li*«. Ihii» 
ft] I N^Att* cif irnll iIim i» |«t* nt STtnu.i* h n rniiil Ji<jiiiiuni nnd 
aUjt oi|iir«^t««i| i<*%fn<«l with nnliart tc)* r« 1« -t mi.} iiillifrt-nt tn fiiir- 
lonk IntrnMlU . jfjuhiini nhtiw- twn nr tlirtt u'.. ••p.. with « I* «nti*i| 
p|«Mpr«l t^'ni*r«. aifl iif iil^'iit •'» I mill, iluiiiptt r II« niu (■•iit«iiii« 
■. mifi* iiiinH'r<iii«i «-MH<«-iiill\ n*-.ir t)if il<«i<.i*,t! \iii%«-. ulitTf tlifV 
flh^ wivilf IiiiiH'M i'l«iT« \i%T\ fp'ni : .' t<* I.* ^ iimi in i|i.iniit«T; 
r tif iht<»- run* .»« a ruU- tr.iii«^ir-M ly with tli- (:■>!. tiii-\ iir<- n<in 

r •'••Inn jir»*i»t» .1 ?• w •iinilar ul.»r-. i-xs rn.il »Jirfit. ^t-ri-*! 

' lQU*rr1f« I.i\ir • nl.iri;»'«l. w*-i»:)t<t -j i'm* t:r.iiM« •■itfrnul oiirfiM-f 
miliary tnU-n It* • ut^ hiinl, • nt ■>«t-ti>it h.i« \i-ry \«-Il<iwi«)i • ■■lur. 
uia'<^l fAttv i|f|(«*iifrati<>fi !*.!?. ri-.-i^ n>>nti.«! 

.1 M K 
• i \V. s. 
/•..'- f. .'. • ; . • 

K. natirity N<*rwii\ :ii1iiii*ti-l %> ?))•■ I i..l*'i ^*.»t« « M.ir;ii< ir*«p:*.il. 

[•I . Nti««^nUr '-M. !'.■•• 'n*!! ■•• rr»'! rr ?. •:.- I t.'.'i-*! '^Mf«** Xl.innr 

rfi*lk V.i ilit^l Nii\* niU r .'*■ "•■•..it ' • ; n. 

f«»rf. K.ilh* r art'l in'*th*-r *h-i%>\ ••.m—- "f ■! .»*K i't^ti-'^«ti •«-.■ *ir»itli- 

i«|rr^. all Imti*; w\ w«Il 

fi'Tjf Ha.! all tlif ilj— -.i^m - tL.i' .»». 'i-'n! . !• !.• • ■ > hiMK'-*!. 

i«i^ Traf AhS** fcT-iji-r.i! I.- i!'*. j *•*. «■*■-♦ •.>•.•. ■ ' \<rii-r*.ftl 

altiry -..\)Binl "Th- Vi-.ir.i.:' j. ••:.:.• ■!•-.•!■;- -l • . ■.^- .i!h.' in\'.*\ 
ti tnt'hariti'i'T ntt* ri<l**M>^ ^1:.:!.* t %•• • • i*: nut.. \\ t^ •-•.•--. -u 
ilh Ii1«*b|. t'ttiikfli u'riiln-il'i^ :ii r- .•■» I m »- -.•r^r. *• «> i-. •'• ;r • 
ibi" llii»niinir«. aMi ;•**- i.it»«l u.Mi fr»- ,-i' :.• • '.i!!\ •• '.x-i* ■!.- .iri<| 
%» ' A« t).** • ••ti«:ii lip rt-.i^ •! * ^> ri \« .t" :t ." nl-i.t! •!• -!:•'- iv U-!\ 
Mr^nirth \l"'ii' ta- lit I.*;... .i^ . ■ ■.. •-. ith- ^v .i*!. ■ \ »,* 
«1«iratii*n %• r\ pr-'f'i-^- \V!.. i. i.|?- ••• i ■ • • ! : • • N i-m'-r 
ifi'al • t4iiiii..i?'.- n • '.:■!*••! .t'l * ■ • • ' ir:i< '■ ' •* -^ !.-.•■ -1 ■- '•in- 

latipri til- «:« ..f !».. Im!..- .iT.'l v.. .|j.»^« ..- ■ • •' • ■ '. • ■. %\ 1^ 
nflr«| ki\ .• fit;, r — . f.-. . Hit. ?..»•• '. ■ f • • •■ .« '. '. •• •. . .il- •! 

■ i»f l;iUrl«- t»»:I Pi* •■ .1 • 1 N \.t., -r *■ '■■ i' ' : '. ■ 

ttr* ill I .'■•I • I I '. ». ». >. \'. r T i". .1; ;« .1 •.»».« « ^^t^. ; i . -•/• 

I 7 III! ii«« pT" !j« r 11 ? I . ii. ■ ! ■ ■ • ;•-■!.:•.! !.\ 1 • . i«. i.| 

ft» 11 .-■■r •!,••-%%■. : I ; . '. »'. •! .i I . ,'. »■ • • i'- '* 

nanlu! ^t* • ii'ii.- ■■!!'•• ■ • if -•: • .. ••-!•'.! • ■ • . • • . il 

waf» rt^lln.i -:■;.!••. Hi-, i.fi'f \ * .*»1 • \- ' j ' ,.r ». 

, llif lit « ■ ■ ar<i.'itii \\ .f .t!- X • ri •! I i it. • » . . .■■ ' 1 • • . r • i' .•• 

f%» i|rUar flNr<iii" tfcii. !« v» • !i- '•-.:.■'• ^ ,.•.!■• M . ' ■ - ■ .m 

■ anil mil >- iij^* • -j- ..•!.; r- i. t • s • .i* !»•> k-. .-I 
«1 !»»•• frtf II. «iiii ?.• r !L.i? .-,;i' P ■ -.i • • • 



■ 41 III*- )• ft ••I. \» •• .i.t. !• '.» ■.. • I . .r . M- I-' \^ ■ . '.•■»' 

Il% •lila*r«t ■•%• r- l ! I .1 -. r •.'•rji. !|- . i . 1 »•■ k- •'• ■ -' •• : i . 

h(C« ftf' *\ • 'n »•• M II ?.*»!■•-»■ T« f '.I 1 .;••■■ ■ .1" .•!'•■ 

WfT*" Ii"lli t-l •'.l,.'L' \ I pT- •.••:*..'.•;• -1' ' •• ■ • ■ . •. . .*■ 1 

•1 Miia'l «!»*■ II. r*«ii. • I: . * \- • *■ ' I* ! .t- . • • t v% . t 

U l»r« i.i w .•« • ■■•- I i • •! * '- .■ .» • 1'. • .• • 1 ■ •• I . 
r« •■' 111.- 11,11 . • II.' iii'-r •!.• I. • . ■; f ■ • »• ! • ■ rt .,- • 
• « *« I ■ afi'l I* .1' * '.I .!'(.». I.i:,- I ■ f * ' • t • .1. - ■ ' • • 

TIm- tr.n \f.» .1! ! Ii !i-..al *.'•■; •• • • ••-•! » • •.■. •. - 1 . if • 

laryiii l.iii.p** I. '• *»•..:••! •..••»- .;-*.,» ." t i)i»- 

I Nil'! !•• ttii il'.-ll'L* . I tl* -1 Ilk' M -• ■ \).' |> • .• "^ • ttt-fiav 

^ lilt- Mitll«-^j- fi« it M <«(• •-••l!t T -.k-iri** '111- I .1..' • r-lif *. !■ ffr^ I 

(hi ■»« li>>ii »• \ I r il •1:1.1.1 • .•> IT •• • M t« • >•« r \ • •! • i.«- • f «i Li. h lj»r 
iC* Mini "ifii^f*-! I I' *' .|« % f.*.il* ••' A^Miiil ^1 I I **i wm 



184 MABINE-HOSPITAL 8EKVICK. 

pumlt'nt fluid. Tlirouj^hont the snhstanco of the lung were unineFoufi tuberclts 
in various stages of rt-trogression, ranging all the way from caseation to necrosis 
and ca\ity formation. Riglit lung weighed I. Mo grams; slight a<lhesions at the 
aix'x and base, but none elsewhere: venous engorgement general: no cavities, but 
many caseous nuisscs. Abdonn^n and contents: Peritoneum revealed no evidence 
of tubc^rcular or other involvement. Stomach distended with gas and contained 
about loO c. c. of watery fluid, mixed with mucoid substance. Small intestine 
normal; mesenteric glands enlarged. Largo intestine normal: vermiform appen- 
dix very rudimentary. Liver: Weighed l.ooO grams; normal; gall bladder moder- 
atel y dist^^nded . Pancreas normal , weighed 63 grams. Spleen weighed 245 grams; 
Arm in ttfxture and of a dark color; transverse diameter almost as great as that of 
the 1< )ngitudinal. Urinary organs: Kidneys— left weighed 19«) grams; ivas marked 
by two fissures, one at either extremity and running transversely . These fissmcs 
gave to the organ a niMlular apx)earance: capsule not adherent. Right weighed 
100 grams: cax)sule not adherent. Bladder normal, contained abont 50 c. c. <tf 
urine*. Brain and membranes: Calvarium removed; dura mater normal; |Ma 
mater and arachnoid were congested, adhered (nio to the other, and in a few loca- 
tions the pia mater was firmly attached to the convolutions of the cerebront 
The brain as a wlirde was amemic; the sulci shallow, and the cortical gray 
matt(T oxtremi.'ly thin. 

G. P. 

W. C. B. 

A. P.; age. 25; nativity, Norway; admitted to marine hospital at Savannah, 
Ga., March 10, WHH). 

Clinical history, tiiken from notes of medical cjfficer in command at Wilmington, 
N. C, viz: 

" Family history negative. Personal history negative. Present sickness began 
a1>out March, \hmh, with cold. Hiis had cough ever since. Has lost 45 ponnds in 
weight, and has become ([uite weak and short of breath on exertion. Physical 
examination March 10, 1N{|9, showc^l emaciation, diminished expansion of ri^t 
chest, increast^d vocal fremitus and resonance nearly all over chest, Bubcrepitant 
rales in left mammary and axillary regions, and cog-wheel respiration in len sab- 
clavicular regit )n. Sputum examination showed a large number of tnben^e baciDi. 
Since above (lat(^ patient has had some ni^ht sweats and temperature ranging from 
«30 to '{s C iSubse(iuently gained in weight and cough moderated. December 1, 
181)0, patient was transferred to the marine hospital at Wilmington, N. C, where 
anoth<*r examination revealed most of the above physical signs.*' 

Admitted to Marine Hospital Sanitarium, Fort Stanton, N. Mex., December 26, 
1HS)9, and pliysical examination on that date showed the following: 

Height . .■) feet H inches; weight, 1 25 ])ounds; blue eyes, light hair, blonde complex- 
ion. Clavicles prominent. Breathing mostly on left side. Chest sunken in at apex 
on right side. The ai^ex and greater |)orti()n of lower and middle lobes badly infected 
and und<.*rgoing pneumonic? infiltration. Tliink there are no adhesions. Very 
little tissue broken down. On left side there is a small focus of infection at apex. 
Heart weak and rapid . though otherwise normal. Coughs considerable and expec- 
torates a great de:il. C'laims he has lost 45 pounds. His condition is fairly favor^ 
able, as ho hits one good lung and the other lung not being badly broken down. 
ApiH'tite poor. Examination of sputum December 28 showed large numbers of 
typical tubercle ba(;illi. small in size. Typical temperature chart. 
\Snhsr(fnriit histitrff.—'For Hoino time after arrival the i)atient gained in every 
way until a scv<'re cold was contrac-ted, after which he began to retrograde. The 
8i)utum was examined many times and always contained large numliers of tuber- 
cle bacilli. The uriuci wjis also fre^iuently examined and a strong Ehrlich diaio 
reaction always ()])tained. The jKjrcentage of hiemoglobin ranged from 80 to 95 
up to August 1"), tlH^ hist time it was taken. During the last month the patient 
was iiiucli t ronbled with dyspnoea, which c< >ntinually increased. About two weeks 
ago dropsy began to occur in the lowt?r extremities, and later invaded the tnink 
and face. Death occurred Octo]>er 1 1 at 12.50. 

Nt'rntj}sif {tin ntij hours after (/cfl//0.— InsiK»ction of lK)dy: Emaciation; post- 
mortem lividity and rigor mortis well marke<^ ^'«^lvarium removed: MenmgM 
adherent to skull cap more than normal, anr* ^hick jm iijfl riy, OClMPr- 

wise th(» cranial cavity and its contents w< ^di ' ~ -*^j»-« 

pleurie of both lungs adherent to the iMjri 
pariettil layers of both lungs adherent, n^ 
^le left apex had a cavity of 7 or ^ 



VAU2fK-IIiK«nTAL ;4KK\ Ic'K. 1sr> 



r ■• Unrr luili vrrrnnptT. SnrmniKhnyr tho raviti* - wi rr • &tiM-i\i> an-iut 
■■i4»l«ll«iii bfilli lanipi wi*rp full '^f tnlHTi-li*» fri<tii .ipn •■<• t<i Ui'm-^. tht-n* 
\\y m t-Q)«4- it-ntiiiH-lfr nf whi'lh iit*riiml ti-^iic iiti\ wip p-. In iIm* riuhl 
A frw hfftiM •ram. Si<\i*nil fii1»rK*'l l*riiiii In. J k'laiiiU ^^*•r^^ \tr* m-ut in 
iluatinnm. TIh- iH'ruHnliiim u-.i- ^■iii«*u|uit •li»t«'ntliil nju\ i-nti- 
I iw^ral iiaikni <if M-n*iiJi lIuM It wa- a«np ti-ni in plaii-f* i«i tht> |il«iir.i*. 
» nciFffml AAtl |«nfl-lal Uyem m-iTv i^trtially ii*lli<-r«-iil TIk- ht-art wa^ mn- 
JUt rnUf||«<«l. Tlir ritfht %«'Utn(-Ii- wiii* lartstr ami it- walN tlii< k* r ihan tin* 
aa o«taia»«| a lanc^ iiiami tif \i>i;«'tiitii.nfi Ih-Ihw tht* xrv ti-pul \al\i*.ihi* lat- 
Mac larv^DiM^rnt in ihf wad r li-t.A^wa- al>»*i tt.f | iiliiiiinar> •« intliinar 
■. Tbr Wl %rtilni 1** m-AN iiiiniial. iImmk'Ii th*- imtral \al\f ua^ •U-i hIinHv 
kl !•• iIm* watiT tf^t 'Ihf ivirtit' «fniiltin.ir \.i!%* « wt r*- ii<*ini.il. ('tin 
• •Intmi XV'Xi* • ti*lini; m t"'th Innk'n. th** i ••iiili!i'ii ••( O.i- n.:)it \i*n 



tnrust i<! Ainl ]iiilniiinar> \Ml\r« i« m-i iiiintt<«l ?• r Tlif ]iiiliip<iiar\ arttTV 
klMU«l iiQl "fh»-rwi««- th«- irr*aT IiIihhI \i-«-w1- an<l iii-r\i-« uin- n- riiial. Tti*- 
■• ckjtf**! wa* n<<t •lfiiH>n"tr.ililf .\1"1"Mmii l,i\«r ••l'.k'iit!\ •ril.iri;*il aiiil 
■ImI TI.v • m|mii1i* i-f Till- n»:ljT knhM'V wa^ ailliff lit. :ii:<! fh< Iiio- tipli«liiM*t 
M th» «<-ri* I aiiil in«'«liilla Thi* u'hII M«MMtr > •'Mtaii.«'i| ImI*- Tit*- iinnurv 
9r r*ii*.Ai;j«^l A *nu»II ain<>niit nf iinn*' Tli** «t<>n>a« li •-••iiraiin'il tlm*] an«l 
•«c««l ?••■! Til** aiiU^'n. |«Miii ri-«ifi ••nj-rari-LaU. !•■?* ki*lfi* > -!i:all iiit'-^titit-^. 
rs,i««7xx»r« i«-niJifi<nii«|i|«-nilii.'iiM*'iitnHi.in**^-iit« n*"> kMlI«li:< '-. krri-at M*"*! 
m. m^\ iftirrHti\f «y«ifni Wfr«* all in ii>>niial ii*n4ii!i<>n. Th> '»<<l.ir ]ilfMi'* 
%JL ihim I trO ixit. tiwiii»( t'j Lftt k «•( tinif. 

r. K 
.1 < I r. 

II A«v M. natiritv. Inlaipl :Mlrnift«<fl !•• I'liiit •! Statt - M.irin*- H<p-;>ital, 

^^»«* A icf -ir y • • -'i f> fi u -f f . ■• ■ •/. I |. .f ,'.■■*••• ' I • I .'■*':•• r' I It •••».• I I fill/, 

*"r^».-^* ' . • •!. J. K:lni'.'.^ l..-T..r\ tfij.r .• !'• r- ? .i'. I.:-' r> «'L:]!- .im<1 
wwrmj yv«r« A.; ' • hat.- r< )>':U> .ii.<! ':! ••: ii r ..!.* \- ^ )..i I k'"ii' r:!!-* a 
9. !its yr«r» Atfii ha«l -s ni.i* )i tr>>M)<'.i - l*r*-^!'>. fi*i< ^o- f t* niifiith-' 
KB. At "at»-f •'t'Uak'ti f--ll'<wi'<l )>\ fn*- • \j"« t>-r.r: .r :i-\'..t. il\ -jiTi-M-a. 
i vn^rht ai<<l |«»ni in < lifl-"t '-n i- <2b:liii.« l.i.ii'.'.r .if ■ r. r.iii.i ::iM'<i> ami 
'S{4UL«.<«-* iii-<r* iir;«< ular ifT-Ti • i* ri.'t.T -.-l' !!.i'i • << .ti- ■ • la^ i- !•■- .ii. 1 
•mm >»l » ;k\<U>i.i; r.^'h! iij-]* r 1 '- ''.r;!.'*" .i"! «■■-•: r-.^'i.r Inn.: |- -•• 
ar*mi<f lii«r •hilin* •« :ii<-r*a"«t1 !»i- t. :.-..i. '••.••);■.!.>: ::• in 'iiri*- •■' r.-'li! 
LttT^h r^'viiirali^'n ••^•■r )»U • l.'-t. • !« • ; ! .ij- \ u!.»-» i. .hm i- .»*■":.•. 
fr»^.stn« iTirf r«-i«iM<tl in .ill ■I'lM .tr«a*. •x- • t! !• '.: .«;• \ .i:.>l r «].; K'i-«« . >« t.* !•• 
!■ b- • fr^ i*Ai.> • t<r»'ii< h ■;}>•-?.> I«l'<wru-li' •'..i\: !• I<.i:r -M.<Na<i*i>; 
Ail HP* • til .« » • « :,*'*aTt«l M.i> 1 • talii i.iT.' Ti 'f. %« « r^l.* !';!:,; a!.>I 1< :! 
I%I1 .kXtl a( ; •* \:.\ ■\\t'\ A'ra!-.'!! ».'— «1 ■!>'■> •■•<[ 1> 'T !';*..:. a^r• i :• rlv 
"•trmll^ 1^ fi !ii!.«: «L «* m- :-•. r.il»-'i»i.'l !■'.••.* :t.,; r- -; i: i!;-! A fi-w Hi...-t 
• r rf?.^ !■.?..• u'.tj, f r !l..- I..- •? j^»r' -'. I..- . 'r^T'.. '. ! T ;I- r. '■ U» illi 
•f**;**.!!. I'r.iial ■ -.'v i«ft;al:\ • Ktj- a*i 'l |>!.\ •!• at • \.il: .: .t' : i.- -'. \* 'hat 
■•■' k" 5 f icr«^*»ili*' I'atlUi! waij'* !■ ■ U ■• I.' !-. I •:'. •-T.»i.'- r. N M- \ 

I .1 I 

ito aZ " «*-lit>if. a- n .!f''l ■■!. arri\.il .i! !'• rt sr. ■!.•:.•.*.»•.»' f . \\ - 1 \ ; . »I 
fciA.:* M,i.\ isuum r'.ul.l •!. -iMi r .!.|ri--t«l \ . .,: •■.!..•.- .-. r- i . '. • .r 
■*-' * '-• 'liniiii..!!, .| .,\, ; ; ft I, .«, .l-.IIi.i »- i!i r.» :.• ; *, - • • : i-- .» 

^^■" '- •''. 'I'll-Lr--* 111 1. •• «}.« I at.l lm«" « r.i. ^ ■ . • . • .. : ■ x i . f. 
*"'•'« i»-'? »;«i Ih art M<> i:ii^| n riita: t'll- : i . ' ■ ■. .* iin 

•*••*- «r«/a air -nh' 'lia'o rtai fl "t, 'II. :-*».»■» .i • » ■ i . r t -•.!:• 

^^Y'*.' iiiij.r..%rni* f! ^^ii.."! • . !.i. . 1 a. ■ :?. ••■ .•• i ' 'i ! 

_ ^ ' *• '•'•»• •■l|a • •••! it* I- „M». * ■ .■■ . -1 « ■. ' .. I • V^ -•■ - .l!i 

^m' '' /'>'* •l«-«r! .J«.l ri...i|.'l| •? ■ till' ■ ■ . ■ '• ,.■■•■. ■ i:..l!.i-! 



r 

1 
I 

■ . ■ ' J . ■ ■ ■ i; .. . : ."■• 

>^^^ tr •• *•• « ii« r ;• l.< r«l !• !• .1.^' .» II. ••? . r. ; • - • i ^ • ' • I- ■•.».■ ■ 

'^'^^ • - -f 111 ''.irtk' „■•»# I .itlur* . - \ - • • ; i' ■. I • . r I t'l »;; . 

^•^ f * A '^ «l«| .ii<* rt I ». rnfti-li it.-'i •. 1- •! • •.\ I- ■: I. : • i . liw i 

!r*>^ •* »••! *•■' ■■•»< M.I- ft.n.J v» ! J !. «.i" '! ;.' ■.' I • ■ • r • ■ i i .it» • - 

f 0^^^^ **■ "- •• » ■ .' rt-.. 1 w .»^ r I!, w .1 .»: I , •. 1 •. 

'•• •'•! f-. I . '• . ai. I -•?• ': •' ! ' •* 'i ■ ►■ •''. T.il 
*" ** '^^kt Si * ' r » ra|'ill . •! .!.-• -iT .' a u. 



186 MARTNK-HOSPITAL 8i:RVI0K. 

Xrvrifptif/ (n'ffhf hottrs aftrr death). — lusiMJCtion of body: Riifor inortiH and posi- 
inort(»iii lividity: wound in ulMlonK^n from operation previous day; csUvarinm nut 
n^nioved. Thorax: Anten«.r modiiiHtinuni had several cnhirgetl glands. HtAit 
normal. Pericardium sulherent to left lung. Right lung almost entirely conaoU- 
dat^'d. Loft lung involve<l at apex, and with many small tnl)ercle8 scatt^^ 
throughout other i)ortion»; but the left lung still had considerable fnuctiozud tis- 
sue remaining. Layers of right pleura a<lherent all over. The left pleura adhe- 
rent to the jwricardium partially. Arch of aortii was dilatinl. The other great 
vessels and nerve trunks normal. The diai)hragm was adherent to the right lang. 
Abd( >men : <.)mentum very thin , friable, and undergoing fatty degeueration. Spleen 
much enlarged and very ant^mic. Kidneys small with capsnles adherent in 
phices. and line bc^tween cortex and medulla nearly obliterated. Suprarenal cap- 
sules could n< >t 1x3 found. Urinary bladder empty. Organs of generation normaL 
Rectum in ])r< )cess of fatty and colloid degeneration. Duodenum nomuil. Stomach 
very anaemic, its mucous membrane almost white. Gall ducts and gall bladder 
normal . Liver small , aujemic , and granular, and infiltrated thronghoat "with what 
apiHMired to 1h> minute tubercles. Pancreas in a state of fatty degeueratioL 
Mesentery thin, friable, and in i)roces8 of fatty degeneration. Small and lar:ge 
intestines more or less glued together, owing to existence of a plastic peritonitii 
with exudation of lymph: large intestines undergoing fatty ancl colloid degenera- 
tion. Their walls were ver>' thick and the muscular substance nearly gone, being 
replaced by large transparent masses of semisolid colloid material, each mass 
l>eing surmountc'd by one or more fatty processes of conical shape. This remarir- 
able condition of th(» large intestines, including the rectum, will account for the 
obstinate ct)nstii>ati( m experienced by the patient. The great vessels were normal 
Between the stomach and spleen was a mass of distended veins. 

Mici'omrnph'dl I'.ntminafion. — Staine<l sections of liver tissue demonstrate*! prw- 
ence <.)f fatty degeneration of the atrophic or wasted form of fatty liver. 

C. R. 
J. O. C. 

Tiihrrnlositt of npin(tJ rnnl a ml syphiJh srrondary, 

J. K.: age, "24 y«^ars: nativity, Louisiana: admitted to United States Marine 
Hospitiil, New Orleans. La., Decenil)er ti2, 1H»9, died August 2«, 1000. 

Famihf hisf(n't/. —Tha family history is vague: father died, the history states, of 
dysf'ntery, though the relatives report that the cause of death was tnliercsnlosu; 
mother die<l during childbirth: of a family of two brothers and five sisters only 
one brother is living: the other brother was killed by a railroad accident: the 
cau.*4<s of death of the five sisters are not stated. 

Pi rsttnal hintori/. — Ten y(»ars ago the jMitient had a fever, which was xnro^^T 
typhoid; seven years ago he had gonorrhcea. which was followed by buboes in 
both groins: shortly after the attiU'k of g<morrho'a a sore developecl on the penis, 
ni»t followeil by eruption. Patient states that the present condition began in 
I)r<^ember. 1^1)0, as a girdle pain just Ih'Iow tin? jimbincns: this pain was scaivelr 
noticeable at first, but gradually increased in severity: about three weeks later 
hi> Ix'gan to have i)ains in the ankles: this pain s])read upwanl, followed 1^ 
l)arjilysis: two weyks later, or. as the history statt^s, five wi^eks after the inception 
of the attack. i]w jiatient iN'camc bedridd(>n: anaesthesia of the skin of the legs 
iM'gan alwnit this time and c<»ntinucd until it was complete: incontinence of feces, 
]jriapism, and brd sores are then noted on thr* hist^>ry, the l)ed sores formed over 
th<» tulM'r ischii and siicnim; about the 1st cjf Aja-il of the present year the patient 
was turned on his face to relieve the i>ressur«' on the dependent sloughing parts; 
tliis brought th«^ pressure on the knet^s. which first swtrlled and then broke oown, 
eroding th^ joint and laying bare the femur several inches, the right knre being 
the woi>t: trophic gangrene also began on the t.<K\sand other dependent pvts. 
Uiiring this tim«' the legs assumed tlie type (thara<-teristic of spastic parapl^pa. 
Tl:«' ii;:ti«'nt gradually grew weaker, more emaciated, and died at T.S.j p. m., 
August. ^r>, 1<M»(). 

Sirrttjtsi/ irif/htnn hours nffrr (hath). — Rigor mortis slight. Inspection 
showed ImmIv to l)e markedly emaciate 'd: the legs are in the siime c<mdition as 
during life. i. e.. crossi'd: there are large l>edsf)res and cicatrices over the parts 
thai si-rved to sujuKirt tht^ IkkIv in its various positions. The most remarnUe 
i ondition, hoNVi'V«'r. i)res«-nted itself in tln^ structures around the right knee; the 
soft structures had sloughed away anteriorly and latterallv, leaving the bladc« 
gangrenous end of tln.t femur i)ro.it>cting st^vt^'al inchc^s. Ail the cartilages had 
di.Mapi»«»ar(^l, but the intt^rartit-ular ligaments were intact: the posterior soft stmc- 
tores were in g(K)<l condition. The condition of tlielfft kneo was somewhat better 



MAKIMK-iKiHnTAI. rtKKVirK. I N? 

• 

^ riirfai ••t»rt«iii>l>l*- ••iil\ |initii<lt^l ihrmKhthfftkiii. )Mit a rHi*i«Uy f»|in%MltiiK 
ttp «r»» iik^kini; it'*\ VT**tiT*-^t^. aii«l thi« kiii-** wmiM hhui liavi- im'-M'tilfil 
Mr ' n<ltti>tii a« ilif i>tli«T Thr aliil«'iiiitMl walN w^n* Ihin. in fiu-t thin* 
ftriv!% a fr^-«- ^f *n|»*rfiiial famia. ih** w*i]l w:ii« atlhfn*iit !•» ihi* •■int*iitnni 
tK«* (•'nc<f»>«l t^tvfiiiiit i»f thf liviT. Thi-«i«* ai|li«-«i<'ii4 \v«>r«* ili««*>«^tt<flaway. 
W«uht '•'..^■iirnuim l'«Miiiiiii: Kzl'tiiN trail- vi'i>i')y iiiT«iMi thf aluliiiiirn 
«*: niith lb«* flftli tiMtJiI i*ariilatfi-. tliii|ilai iiii; thf th«>ra«-ti' viMfni ii|iwanl 
tK th^ •SiAiarh. atiil t*i a iiiimII «*sti*iit thi* hplifii. T)i«' liiii*(if Inwrr hmiiwl- 
brttri> tnuiiiTri>i« a<-r«MM tbi* alM|iiiiitn:il cavity aUnit -'i rtn. almvi* thi< uiiiHl- 
[| s« »!>>rr%-nt t«»thfat«l<«iiiiivil wall, thf (li.i|ihr.itfiii. th«*fit<>iiia«-h. thfHplt^'ii. 
OTT' -^* • t.lta. anil t!.** iiiti^tiii«i*. Th«* c i]»^nl«- it a<llitrfiit. oiliir i««Ii|{htfr 
< rr..ft! i^f«nttn* \\\*'t ■•tni«-tiirf i-t tillftl with amvl'ibl UMlifn. imn'iically 
t.- a;n->iii'l t|«-o-n* ratii>ii A* i'%'i«|fiii •• that tlH- i>ri;;iii h;iil tnH-n aliiHi^t 
«>•• f r »'t}if tiiM*' the i;all lilatlili-r wa^ fiiiiinl i|iiili' fiii|ity ami Hhnwttl 
It's r f vtA:!!;!!^- fr>'in I'ilf nali^. Sti«iii.ki h a]i|Hip iitly f^iiialli r in ••i/.t* than 
ih<r«i<! t<i all iinrpMin«liiit: Mni<tiir«r>. sph^n: W^'iirhi I'hi ^'nitiiH, 




^ 1-. h^t»t*-Ti« y that «>n ••<•• ti<<n t\w \».%r*'U» hyiiui ih»/i'<1 fmni i aii^nli*. Thi<* 
a:*- »l*i«-n-nt I • tlif «-irr>iin«liiit; Ntrinttin^. Ij«*fi ki«hi«'V: Wii;;ht Hih> 
mr:\» A'lh n-nt. i**I«' ill i*<*l«ir. -h-twt r\ iih*ni-a<«if )»itli aiiivlniil ami fattv 
• 41 Ku'ht kiiliH> W*-ix'ht J**.' k'raiii'-.i aji^iili'a'lhi n nt.iialfin«-i»li>r.iiii«l 
If il»'«:*Ti«-nili%'frtianAef^ an iV* f* Ili>w. hut if**. f*'iiiiarKiil. Ap|H'nilix: 
<4»V7; \'\ »lhi«h*iintitihi*|»-nt«infiinii>f t}ii'aU1«iiiiiii:iiw-.»!liitp!i-.i-<i-iini. M- *•- 
N n.-al 171 att* Liiifnt.-*. t-"iih;»-**t«tl in a]*]»*.ir.ini t*. litinMi-tl with miliary 
jF« a:. I- -.\»T«^1 with«irir.«ni/«^l lymph. I*tTit"n»-uiii:Stii<Mit| withtiiU'n'Ii -. 
>S «:*>i "f jai.;/««l l\iiiph.anil alliip]»-«i;i*;«*'irf.i(-t>'« iflhiTvnt. ThM wa^ f-in- 
E-ark'*! «» :ih th" iip"^ ritfr\ . whii h w.i.-t ailhi r* lit ti*lhi' livt-r. Htiiiiiiuh. i:it«*H' 

■ 

ko! a*.*«>r: «7 at'l"miiial wall !!• ar? 1 hi<« i*r;:an wat lll^I•lAl-••«l ii|iwar«l ami 
jp'r • . ??:• I \< ?.• aii!*iii4 It t.. '.!•• :ii a :ran-\ir*<*'I«t.iti..ii. >i-fi(fht:r.ii( Kram : 
'.^*. . » . 1. fai ai.'l 1 Mrraitt j» llv • ! ■!-. tIj- \t ii!r:« Ii- wi-n* nli^rhtlv hyi- r- 
(^i A-. . t.^" ■• •;*•-• w>r**iii1.ii t Li'i,;* I.»'fT. wi-ii:ht T>» fcrriiiit.anif nv ,k ••( 
.r. • • T.. »;• \ a'.'l a f- w- at!' :••! ruU n !• - Kik'l.r m>ir«'<-iiiiu'»Mf«lat th** 
r^Aj ' '.«;.!• •SiLftiMii*; u*"T'- tuU'ri !• • Th«* )ii>-ta ri<T iii«i|i.uitinuni: Afi*-r 
.&* *:.• t "n^ !•* «i«it ra an alt« •-• • «.»• i-iiiiM U* !miii fxtfnilinK d^wtiwanl 
i^ f .:"*i 'l r^il \t rt« hra U-hiiitl th** iliaphnunn. I*i th«* |miiiu« niiiM'l**, thi* 

• f ..-I. .^ I«-f'<niiiitk't)if»^ i:i Th:«I<« atii*n. Thi<«f«.ft4' w;iMii|a'niil thnniu'h- 
r«:«: • v. •; ::^|i ••Inipiii f'>riii*«il ihi- j-«**fn"r ln'iiinlary; th- \rrtfhrjp w^t 
ml ' ,' ' '■■• .i:j thf \«r*ihral I aii.il U'lr.*; i«|«mi» 1 111 •".Virall-ati**!!*. xh '\\ 
If «' 1 . ''.' •'.•^'ni« t >ti «>f th** -;>:iial I 'III I h*- |>ii<t wa<« of tin* < hara« tfr 
k ^» , ••; i ? ..»! . t;.' ;.'i f tin t .•■?!!• Uit I'li I'.p-t iii>>rfi in ilia.'!!'*-!-. 
- ^ ' •, ;:^1 • • .'in.u ( ••mi«li< atl>«i;". spinal ]>.iral>-i- with >|o .i« r«*m]».tn> iiih; 

II It I*. 
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§r fi-l r^-*! •4^• ill: natMitv 1^ •Indiana iwlmitt^-*! t>> x)i*' I'mtf*! Static 
r 11 •: Xjkl N«>w itrUaif. I^i N .\«iu!" r !'• !'.■■» *\u-*\ N-winI- r ;«« "■■• 

• • ■ <,•''- 1 l*Ati> ht »tati « ti..»t h<- \%.»^Tah«*n «!• k viith hriiinhitw iil">iit 

vf - : *f.- ]*r*-^-t.i iii>'tith a',-|ihi«i t<i th*- ■•lit {kiTiiiit liffi n N<<\i-iiiU-r I 

ft»-f. •♦.••- • a.* l»"«-ii ii-i lilt; r't\ i-iiii lit N vtT.»l ilax ■• atf" l»-.' »u ■•|il?»lli«' I'!- ■ ■! 
««^b.'^? '•>*!! ii;i « • ••ii«|i|i ralil*' •|(iaiiT Id I -f Iit<»-1 i tti \ii\ t-iiiL-r i'twa** 
L*«l !• 1!.«- h'«i|>i*al At '.' '<i a li. lt>*< f 11-wiii.r Hi -rri.i..' U jaii . i.'l.wii^' 
«^t;-«;t4«al II* f«-ll H 'ill'- II; watf r • I'^w-t h«-ar<l hint fall 1 ).' •••ir««- nii 
1 f • i''\ Tf«« |«»l|t-iit Ii lilt; i.ii th*' n Mir iinrfii'* '••ii« u I* ii M>> -I »'rt .itiiiii j f r<<iii- 
rr- mf*\ iij'Vtth Til*- Mn*l»laii' "Mr,ri«i!i Wa« th* li • a.h-<l • -ii .»rri\al !.• 7"iiiii| 
fr «*« r atll» t 

' i*9 ' -•''"'• ' r* *tft»t •/'•if/.' 'I h*- '-vii :- wi-il ifiirt^h'*! .iii>l vkiII 

%w^l rii*-*f 111* riia prv^v'iit .tii<l tuark*-*! Th* l«-!v \«.»<< •■;>«-iit -1 .n..! tt il 

ft ■■! . i>*l *'i«' ••ru'Aii* 'halt Wl!h -a-natiin Il-.»i*- N-t in.il Pi • 1/ i?!< il 

• «.ipi->*(nS I. • ••II. rr {■•th«'i<'K'i< .tl li-"ti It I. *• '1 M'.ktt \Vi .jl.t ■ '• .:r iiii- 
•I:? • 4i^r» f««l Aliil •llipf^ lit:tr.il ii-r?:- .if>>l tr:i i|^|<.>l ^.t!\*-* i."riii.il 
j^S.Tiifi ••if«'«iii« al*'(it '■'* •• >f t1-.;<l II -rii..t! in a|<|« .ir .i:.> *- I.*7T hiii.* 
KT ^mt ftmtif I r«-|tltiilit Ihr- ••i,:li<iii( Il • .» thi-.-iii« ■ ••ii?.t:i: ■ .1 -tii.ill .kin- 'lilt 
■I (l-Ar f.* lij«|iirall' II «|» I «i;';-.iri-!t?.> fr>*' fr"fii ''lUr*!'- K .'* hiri.* 
kf *»f|fr«n«* »lh«'r«-iit Nt u|" t nt.-l 1*1 -Iiiall !••' Iii--* .if i: ri ^'ul ir i;,'* ' \ tl-- 
#»atAJ 1^ qra. Ii*i a*lt*t-«i"ii* t'iil. ip r «.'iii t' ■• p t tr i \ -.« i !! in »* ki •! t ■i''* t 

• i# r*«'r1it tflTtiflli imt'lii " lii* .ilM-l. ppHln" li«i.' Willi tl<i- lali.'i liiiiuU I 



188 MARIKE-HOSPITAL SEBVICE. 

• 

of tubercles and their inflammatory zone, almost complete consolidation. TSm 
small cavities are seen, one predi8])osin;< to the immeiliate cause of death. It« 
situated in the narrow strip of lunj< tissue iK'tween that branch of the pnlmonary 
artery and bronchus that supplies the apex of tlie lun^. Coinmiiiiicatif>Ti was 
apparently first uia<^le with the bronchus, and then the ulcerative iirocess atracked 
the artery, establishinj^ a free (jomniumication and clausing death throngli hemor- 
rhaj<e. Pleura: Normal on the left side; adherent to the lung on the right siile. 
as previously stated. Aorta and vena cava are both normal. Spleen: Smaller in 
size than normal; weight, 1S."> grams; structure apparently normal. Loft kidney: 
Weight, 170 grams; apparently normal. Right kidney: Weight, 150 grams: 
apparently normal. Liver: Weight. l.OJK) grams; slightly enlarged. Imt no path- 
ological lesions are noticetl. Gall bladder contains about 15 cc. bile. Stianach 
and intestines apparently normal. Appendix about 13 cm. long: free from me*> 
appendix except about 3 cm. at base. Urinary bladder empty. 

From i)ersonal observation I would estimate that this man lost alK>ut 'i <|narts 
of blood before death, death being caused either by the direct loss of Idood or by 
suffocation. Post-mortem diagnosis: TulKirde of lung. Complications: Rupture 
of the pnlmonary artery into the superior bronchus of the right tride. 

H. B. P. 
C. P. W. 

J. S.; age, 30; nativity, Kentucky; admitted to the United States Marine Hos- 
pital, Evansville, Ind., July 14, 1900, and died Novemlxjr 8, IJXM). 

History. — On admission he complained of having been sick about ten dsi^'s with 
fever. jMiin in left side, and a cough. His respirations were short and rapid. 
Examination showed extensive consolidation of left lung. Case was diagnosed as 
lolxir pneumonia. He did not improve. Fever remained high. Case was read- 
mitted on August 7, 1900, as tubercle. He failed rapidly, and died at 3.45 a. m.. 
November H, 1900. 

Nirrops}/ {twelve and one-half hours after death). — Rigor mortis was marked. 
Pupils dilated. General nourishment of Inxly very poor. Heart: Weight after 
oiMining, 340 grams. Wall of right ventricle was thinner than usual, otherwi» 
the heart was normal. Pericardial sac contained about 25 c. c. clear flnid. Left 
lung: Weight, 1 ,847 grams; was one mass of tubercles, with two large cavities 
full of thick pus. One cavity was in apex of lung and the other one \vas in lower 
lobe. Pleural cavity on that side was obliterate<l. Right lung: Weight, 833 
grams. The apex and upi)er parts lower lobe were involved. Pleural cavity nor- 
mal. Liver: Weight, 2,345 grams; congested. Other>\'ise normal. Pancreas: 
Weight, 155 grams; normal. Spleen: Weight, in'3 grams; normal. Left kidney: 
Weight, 232 grams; normal. Right kidney: Weight, 238 grains: normal. All 
other organs and tissues normal. 

J. H. 0. 

L. J.; age, 56 years; nativity, Canada: admitted to United States Marine Hofr 
pital, Cleveland, Ohio, June 21, 1900; died Sept<?ml)er 2^J, 1900. 

Clinical history. — Patient began to cough alxmt four weeks previons to being 
admitted to hospital; has had st'vere night swcrats, profuse purulent expectoration, 
diarrhea, and has had some pain in upper part of right side of chest: he has lo«t 
alnmt 27 jMrnnds within the last two months. App^ttito is poor and patient is 
emaciated; has dysi)n(pa on exertion. Supraclavicular s])aces are deep: clavicles. 
l)r«>miin*nt. £x])ansion of left side of thorax is retarded. Respirations are hur- 
ried and suiK»rficial. Breatliing at lK>tli apices is roughened. Left infracla\icn- 
lar spacr* is dull. There is j)n)l(>nged ex])irati(>n over both apices. Over both 
lungs, anteriorly and iK^steriorly, lond, moist rales are heard. Area of heart 
dulln«*ss is incn-asod; hoart scmnds are loud, and ])ulse is quick and rather weak. 
TulKjrcle bacilli found in lar^'e numlHTs in sputum; also staphylococci. Sputum 
is profuse and ]>urul(*nt and of a nummular character. 

Xrcntpsy {fire hottrs after drath). — Body of an Indian, of medium build; rather 
emaciated. Enlargenn nt of Imhics of loft leg just l>elow the knee, caused bv 
callus of fracture, liigor mortis i)resent. lIyi)ostasis is ])resent over the back 
from occiput to sacrum; also over i)osterior surface of arms. Calvarium was not 
remov<rd. Heart, normal siz(j. Then? was cakrareous <leix»sit on aortic aemilnnar 
valves; other valves were normal. Then; was a dilatjition of ascending and trans- 
verse portions of arch of aorta. The walls of aorta were rougfi, and ccmtained a 
calcareous deposit; right side of heart was filbxl with a jKwt-mortem clot: peri- 
cardium was thickened. The bronchial lymph glands were enlarged and con- 
tained calcareous deposits; also caseated tubercles present. Lungs: Bothlnxiga 



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190 MARINE-HOSPITAL SKRVICE. 

weight, 415 grams; dimensions. 22 by 1« hy 5 cm.: slate color: crepitant throu^rh- 
out; bloody semm exudes from cut surface on pressure. Left Inng: Pleura 
adherent oVer whole surface of lung, so it is impossible to remove the organ with- 
out tearing it to pieces: tissue of organ more dense than right lung and has the 
appearance of jmrtial consolidation: blood and 8«^rum exude from cut surface. 
Spleen: Adherent; enlarged; weight. 405 grams: dimensions. 14 by 5 by 10 cm: 
two accessory spleens near hilum. The organ is retldish brown in ctdor, very firm 
consistency, and is cut with difficulty. Left kidney: Weight, 200 grams: dimen- 
sions, 13 by 8 by 3 crin. ; pale yellowish-])rowii color. Cortex 1 .5 cm. thick: streakf^l 
with yellowish liiK^s and many yellow spots the size of a pin bead: tissue tinii: 
pyramids normal in size; much fat in pt'lvis. Right kidney: Weight, 300 grams: 
dunensions, 12 by y by 3.5 cm.; appearance i>recisely the same as the left kidney. 
Stomach 1(J by 7.5 cm.; contains yellowish fluid in small (quantity ba\-ing the 
o<lor of brandy; pancreas normal. Ascending colon bound to the right kidney 
and to the iliac fossa by dense adhesions; sigmoid flexure 1x>nnd dow^u to tbe irea- 
cum; probe from the wound in right groin passes into an abcess cavity about the 
size of a walnut beneath ceacum. Only the i)roximal end of the appendix can be 
identified. The lumen is closed. Lower i)art of small intestines is full t»f dark 
brown fluid; areas of induration 1 by 5 cm. in the small intestine, just alx)ve the 
iliocaecal valve; they run transv<?rse to the long axis of the intestine, small points 
of hemorrhage on tlies*? areas. Oacum distinctly indurated, small ulcers with 
hard margins in ceacum. and lower 2 inches of ascending colon. Mesenteric 
glands enlargwl. Liver: Weight. 1 ,OSI grams; dimensicms, 32 by 15 by cm.: dark 
chcx'olate color on surface? ; dtH'p reil-brown color on cut section: tissue firm and 
dense. 

W. G. S. 

C. J.; ago, 37 years: nativity, Norway: was admitted to the United States 
Marine Hospital. \yoTt t)f San Francisco, Cal.. July 2, IJMM), and died AuKiiAtT. IQOtL 

Hifttorff. — Family history negative. Patient entered hospital complaining of a 
(rough which had resisted inedicatirin for al)out three months; also complaimsd of 
I)aralysis of right side of face, and a discharge from right ear. E^xpectoration ww 
profuse and purulent. Patient's voice was very hoarse, his throat pained him. 
and he found it very difficult to talk. Examination showed consolidation over 
left lung nearly to base, and consolidation of right aj^ex to about the third rib. 
Tliere were crepitations all over right apex, and bronchial breathing over upper 
part of right lung. Tubercle liacilli were di.scovereil in the sputom on July 5, 
1}H)0. Patient gradually lost weight, cough and expet^toration became worse, and 
his puis*? liecame very weak. On August 5 the jmlse was very rapid and feeble. 
puLs(> rate being 130. with great dyspna»a. feet and hands were qnite cold, and 
some (I'dema of feet. There was extreme t4.»ndemess over left side of chest 
Examination showed dullness anteriorly over ajwx of right lung down to third 
rib. In l<'f t apex a cavity was ( vident. On auscultation, anteriorly, lond bronchial 
breathing and crepitation was heard ov(?r entire right lung. Egophony heard 
over lett hih'x and almost entire absence of l)reath .sounds. 

Amjust ;.— Patient failing rapidly, extreme dyspnoea, pulse very rapid and 
feeble, later in afternoon lH?came miconscious and died. 

Treatment at first consi.'^ttMl of creo.»*ote and oil, maltine and whisky. This WM 
s(K)n abaTidoned, and his strength w:is maintaine<l by a nourishing diet, whi^y 
an<l strychnine. His right cyo was washed twice daily with a solution of boric 
acid, his ear was treated with jHjroxide of hydrogen, and a B])ray of Dobell's 
solution uwd on his tliroat. 

iWvrnftstf {ciffhtren fumrs aftt r (huiih). — The lM)dy is that of a i)oorly nonriahed 
white a<1ult male. Post-mortem lividity is slight; rigor mortis well marked: &i- 
ger nails bhi(», and (edema of feet and legs. A])dominal cavity: Serotis fluid not 




flui<l. iH'ing (entirely obliterated liy pulmonary atlhesions; the left pleural cavity 
also <-ontains a larg<Mpiaiitity of offensive gas. the lung l)eing retract-ecl. Pm- 
cardial cavity cr)ntains lOD c. c. of clear fluid. H(»art: \Veight, 255 grams: slightly 
smaller than normal, llabby. aii<l pal(»: the valves were comi^etent; interventric- 
nlar fat somewhat increased: no sclerosis. Lungs: Left, weight, 050 grams; con- 
soli(lat<'d tlirouglnmt: sinks in water; several caviti<'s. from the size of a cherry 
to that of a lemon, in snjH^rior loli-s: lung much ingiiientvd. and made np almost 
entirely of tulxTcles. Right lung, weight. 1.050 giams: surfacre covered uy many 
old julhesions: a] k^x solidified; dis.s<'minat^'d tubercles and tubercular foci throogfa- 
out lung; cavity size of a cherry in ai)ex; lung fiotits. Liver: Weight, 1,680 gnuns; 



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192 MAWNE-HOSPITAL 8EBVI0E. 

A. P.: ago, 45; nativity, Ohio; admittefl to United States Marine Hospital, 
Fort Stanton, N. Mex., Afarch 8, 1000; died September 29, 1900. 

Historif {roudctised from rliiiivcd uofrs of medical officer in command at St, 
Louis, Mo.). — Admitted Fel)nmry 17, 1900. Family history negative. Present 
sickness ])egan about nine weeks ago with soreness in diaphragm on jireasure and 
on walking. CNmgh devolopwl, rapidly getting worse. DyspntBa. weakness, loss 
of weight, little expectoration, anorexia, and bowels irregnlar. Two chills ten 
weeks ago. Increiised v(x*al fremitus on right side; rt»spiration at right apex 
slightly rough an<l jerky. Aik?x iK'at diffused. Smooth systx)lic murmur present 
Pulse high tt^ision. Ai)parently a small hernia on right side of abdomen. The 
sputum contained many pneumococci, and later tubercle bacilli. Transferred to 
Fort Stanton. 

W. G. S. 

Condition as noted on arrival at Fort Stanton was as follows: Body fairly well 
nourished; riglit sid(» somewhat depressed; tumor to right of umbilicus, with vari- 
cose veins. Palpation: Vocal fremitus over right ai)ex; abdominal tumor givw 
impulse on coughing. Percussion: Pitch of right lung highest; spleen enlarged. 
Auscultation: Bronchial rales over both lungs; cog-wheel respiration: vocal rem- 
nance stronger in right lung sui)eriorly. Heart: No murmur detected : apparendj 
normal in all resi>ect«: pulse rapid. Sputum showed a few tubercle bacilli. Uri- 
nalysis negative. Gave a history of malaria, rheumatism, and alcoholism, bat 
<;onwaled his having had syphilis, w^hich was revealed during the necropsy. His 
lung symptoms rapidly improved, but the liver and spleen began to enlarge con- 
siderably, and, together with several malarial attacks and one very severe attack 
of articular rheumatism, his physical condition became very poor. A lond mitnl 
murmur developed in the course of the rheumatic seizure. The notes from St^ 
L(juis mentioned a '' smooth systolic murmur,** but it was not detected here oo 
his arrival . Several days x)rior to death acute nephritis suddenly developed, br^- 
ing alM)ut the fatal termination September 29. The urine during this uttter time 
was scant and loaded with albumin and casts. 

yrrntpsy {tu'ruty-foiir hours after death). — Inspection of body: CadaTeric 
rigidity and post-mortem lividity well marked; face and body bloated and sonie- 
what cyanotic. Calvarium not removed. Thorax: Several enlarged glands in 
the anterior mediastinum. Layers of pleune adherent to x^ericardinm on 1^ 
side and to diaphragm on right. Visceral and x)arietal layers partially adherent 
in phues. The lungs each c(mtained scattered tubercles, most marked in the 
right apex, which was in a pneumonic condition. Many healed areas of scar tis- 
suti were X)resent. The lungs were somewhat congested and the bronchi contained 
frothy matter. Heaii; much enlarged, and mitral and aortic valves incompetent 
to the water test. Masses of veget4itions on mitral valve and in the aorta, 
causing tstenosis: one leaflet of the Jiortic valve destroyed by vegetations. 
Pericardium thickened and contained a small amount of serous floid, psr- 
tially adherent to left pleura.'' Alxlomen: Omentum normal. Spleen enUurged 
and contained several large gummata, also a wide liand of connective time 
C07) strict ing its middle: adhesion to tail of pancreas and left suprarenal caih 
sule. Kidneys swollen and c^ipsules tense, but not adherent. Considenliie 
congestion of cortex and me<lulla; also several well-marked gummata in each 
organ. Right suprarenal in normal condition; lefteidarged and adherent to tail 
of pancreas. Urinary bladder, organs of generation, rectum, and dnodennm in 
normal condition. Stonia<-h dilated and contained undigested food. Gall dnctB 
normal. Liver much eidarged and in state of hypertrophic cirrhosis: several 
large gummata j)resent. Tail of the pancreas adherent to spleen and left supra- 
renal (•a])sule. The mesentery, small intestines, large int<?stines, and the greti 
vessels normal. Atrophv of alxlominal muscles on right side. 

C. B. 

J. O. C. 

W. R.: age, ;).">; nativity, Illinois: admitted to United States Marine Hospital, 
Fort Stan t(»ii,N. Mex., February U. P.MM): died Octolier 0, mK). 

IlistiH't/ irniidi'iist'd fnnii. clinical tKdrs of iia'dical officer in command at St, 
Ltniis. Mo. ).— Family history negative. Perscmal history: Pneumonia in left ode 
in 1SS4; also malaiia. Syphilis in l^HO. Chancroids twice. Present sicknen 
iK'gan in June of 1S1IJ». from ex]>osnre to storm. Caught a heavy i>old. and has had 
slight cougli and ex])e<'torati<m ever sinc(j. Admitted to Marine Hospital, St 
Louis, Mo., De<'emlK?r 5, l.Sl»9. Anaemic apjx'arance, flat chest, dyspncea, con- 

"Tbtt^ri'nt vos.s4.>1h. norvct ti'nnkM, und diaphragm normal, except that the pleuiml 
tho latter wvn; iwrtly adhtfreut. 



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188 MARINE-HOSPITAL bERVICE. 

of tubercles and their inflammatory zone, almost complete consolidatirm. Two 
small cavities are seen, one pre<li8ix)8in^ to the immediate cause of death. It is 
situated in the narrow strip of lung tissue between that l)rancli of tlie xmlmonary 
artery and bronchus that supplies the apex of the lung. Communication was 
api)arently first made with the bronchus, and then the ulcerative prcx'ess attacked 
tlie artery, establishing a free commumicatiou and causing death through hemor- 
rhage. Pleura: Normal on the left side: adherent to the lung on the right side, 
as previously stated. Aorta and vena cava are both normal. Sph>en: Smaller in 
size tlian normal; weight, 18.") grams; structuro apparently normal. Left kidney: 
Weight, 170 grams; apparently normal. Right kidney: Weight, l.'iO grams: 
apparently normal. Liver: Weight, 1.690 grams; slightly enlarged. Imt no path- 
ological lesions are noticed. Gall bladder contains about 15 cc. bile. Stx^mach 
and intestines apparently normal. Appendix about 12 cm. long: free frcmi meso- 
appendix except about 3 cm. at base. Urinary bladder empty. 

From personal observation I would estimate that this man lost al)out 2 quarts 
of blood before death, death being caused either by the direct loss of blood or by 
suffocation. Post-mortem diagnosis: Tul)ercle of lung. Complicaticms: Ruptnre 
of the pulmonary artery into the superior bronchus of the right side. 

H. B. P. 
C. P. W. 

J. S.; age, 30; nativity, Kentucky; admitted to the United States Marine Hos- 
pital. Evansville, Ind., July 14, 1900, and died Novemlx»r 8, 1900. 

History. — On admission he complained of liaving been sick alx)ut ten days with 
fever, i>ain in left side, and a cough. His respirations were short and rapid. 
Examination showed extensive consolidation of left lung. Case was diagnosed as 
lolKir pneumonia. He did not improve. Fever remaiTied higli. Case was read- 
mittecl on August?, 1900, as tubercle. He failed rapidly, and died at 3.45 a. dl, 
November 8, 1900. 

Xecropsy {twelve and one-half hours after death). — Rigor mortis was marked. 
Pupils dilated. General nourishment of body very poor. Heart: Weight after 
oi)ening, 340 grams. Wall of right ventricle was thinner than usual, otherwise 
the heart was normal. Pericardial sac contained about 25 c. c. clear fluid. Left 
lung: Weight, 1,847 grams; was one mass of tubercles, ^vith two large cavities 
full of thick pus. One cavity was in ai)ex of lung and the other one was in lower 
lobe. Pleural cavity on that side was obliterated. Right lung: Weight, 935 
grams. The ap^x and upi)er jmrts lower lobe were involved. Pleural cavity nor- 
mal. Liver: Weight, 2,845 grams: congested. Otherwise normal. Psmcreas: 
Weight, 155 grams; normal. Spleen: Weight. 1(»2 grams; normal. Left kidney: 
Weight, 233 grains; normal. Right kidney: Weight, 2:38 grams; uonnal. All 
other organs and tissues normal. 

J. H. O. 

L. J.: age, 50 years; nativity, Canada; admitted to United States Marine Ho0* 
pital, Cleveland, Ohio, June 21, 1900; died Septeml)er 2?i, 1900. 

Clinical history. — Patient began to cough about four weeks previous to being 
admitted to hosxntal; has had severe night sweats, profuse purulent expectoratioQ, 
diarrhea, and has had some pain in u])X)er part of right side of chest: he haslort 
alxmt 27 pounds within the last two months. Ap|X'tite is iKX)r and patient if 
emaciated; has dyspnoea on exertion. Supraclavicular spaces are deep; clavicleB, 
prominent. Eximnsion of left side of thorax is retardc^d. Respirations are hnr- 
rie<l and superficial. Breathing at both apices is roughened. Left infraclavicn- 
lar spaco is dull. There is prolonged expiration over both apices. Over botii 
Jungs, anteriorly and posteriorly, loud, moist rAles are heard. Area of heart 
dullness is increased; lit^art sounds are loud, an<l pulse is quick and rather weak. 
Tul)ercle bacilli found in larj^e numlHTs in sputum: also staphylococci. Spntnm 
is profuse and ])urulent and of a nimimular character. 

Nrcropsy (Jire hours after «lrath). — I3()dy of an Indian, of medium build; rather 
emaciattxl. Enlargement of bones of left leg just l)elow the knee, caused bv 
callus of fracture. Rigor mortis present. Hypostasis is present over the back 
from occiput to sticrum: also over i)osterior surface of arms. Calvarium was not 
removed, H<»art, normal size. There was calcare<jus deposit on aortic semilonar 
valves; other valves were normal. There was a dilatation of ascending and trans- 
verse portions of arch of aorta. The walls of aorta were rougfi, and contained a 
calcareous deiK)sit; right 8i<le of heart was filled with a post-mortem clot; peri- 
cardium was thickened. The bronchial lymph glands were enlax^ged and con- 
tained calcareous deposits; also caseated tubercles pn^sent. Lungs: BothlimiS 



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190 MARINE-HOSPITAL SERVICE. 

weight, 415 grams: dimensions, 22 by IH hy 5 cm.: slate a)lor: crepitant thninj;h- 
out: bloody senmi exudes from cut surfate on pressure. Left lung: Plepra 
adherent over whole 8urfa<je of lung, so it is imix)ssi])le to remove the organ with- 
out tearing it to pieces; tissue of organ more dense than right lung and has the 
appejirance of partial consolidation; blood and scrum exude frr^m cut surface. 
Spleen: Adherent: enlarged; weight, 405 grams; dimensions. 14 by 5 by 10 cm; 
two accessory splt^ens ne^r hilum. The organ is reddish brown in color, very firm 
consistency, and is cut with difficulty. Left kidney: Weight. 200 grams: dimen- 
sions, 13 by 8 by '4 cm. ; pale yellowish-brown color. Cortex 1.5 cm. thick: stre^evl 
with yellowish lines and many yellow spots the size of a pin head; tiasuo linii; 
pyrami<ls normal in size: muc^K fat in pelvis. Right kidney: Weight, 200 giamtt; 
dmiensions, 12 by H by 3.5 cm.; appearance precisely the same as the left kidney. 
Stomach 16 by 7.5 cm.; contains yellowish fluid in small quantity ha^-iug the 
odor of brandy; iwmcn^as normal. Ascending colon lx)und to the right kidnny 
and to the iliac fossa by dense adhesions; sigmoid flexure lx>und down to the cea- 
cum; probe from the wound in right groin passes into an abcess cavity about the 
size of a walnut beneath ceacum. Chily the proximal (»nd of the appendix can be 
identifie<l. The lumen is closed. Lower \mvt of small intestines is full of dark 
brown fluid; areas of induration 1 by 5 cm. in the small intestine, just above the 
ilioca<»cal valve; thev run transverse to the long axis of the int^^stine. small points 
of hemorrhage on these areas. Ceacum distinctly indunit<^, small ulcers with 
hard margins in ceacum. and lower 2 inches of jiscending coUm. Mesenteric 
glands enlarged. Liver: Weight. 1 ,0H1 grams; dimc^nsions, 22 by 15 by cm.: dark 
chocolate color on surface; dcM*p rtMl-brown color on cut setttion; tissue firm and 
dense. 

W. G. S. 

C. J.; age, 37 years; nativity. Norway: was admittfnl to the United States 
Marim? Hospital, iK)rt of San Francihco. Cal., July 2, l}K)0,anddie<l Angrist?. 1900. 

Jlistifrff. — Family history negative. Patient entered hospital complaining of a 
cough which had resisted medication for al)out thr<*e months; also complained of 
]>aralysis of right side of face, and a discharge from right ear. Exi)ectoration wm 
prof n so and purulent. Patient's voice was v<^ry hoarse, his throat pained him. 
and he found it ^ery difficult to talk. Examination showe<l consolidation over 
left Imig nearly to ba.He, and i^(msolidati(m of right ajiex to about the third rib. 
Then> were crtipitations all over right ap(?x, and Ijronchial breathing over upper 
jmrt of right lung. Tulwrcle iMwilli were di.si"<>vere<l in the 8]mtnm on July 5» 
IWOO. Patient gnulually lost weight, cough and expectoration became worse, and 
his i)ulst» l)ecamo ver>' weak. (.)u August 5 the jiulso was very rapid and feeble, 
pulse rate l)eing 130, with great dyspncea, feet and hands were quite cold, and 
some (edema of fc»et. Thcn» was extreme tenderness over left side of chert. 
Examination showed dullness anteriorly over ajHJX of right lung down to ihizd 
rib. In h'f t a])»'x a cavity was < videut. On au-scultiitiim, anteriorly, loud bronchial 
breathing and crepitation was heard ovr^r entire right lung. Egophony heud 
over left apvx and aluKkst entire ab.senc(» of breath s(ninds. 

Afitjnsf /.—Patient failing rapidly, extr(?me dyspncpa, pulse very rapid and 
feeble, later in afternoon Inrame unconscious and died. 

Treiitment at first (^onsirted < »f creosote and oil . maltine and whisky. This WM 
Hinm aluindoned, and his strcTigth was maintained by a nourishing diet, whidiy 
and strychnine. His right ey(r was wasluxl twice daily with a solution of boric 
acid, his ear was treated with |>eroxide of hydrogen, and a 8])ray of Dobell's 
solution ust'd on his throat, 

\icropsi/ {riyhtrcfi bourn aft* r liraih). — The lK)dy is that of a i>oorly nourished 
white adult male. Post-mortem lividity is slight; rigor mortis well marked: fin- 
ger nails blu<\ and cedema of fret and legs. Al)dominal caNnity: Serous fluid not 
increased and no great discoloration of contr'uts. Chest: Left pleural cavity con- 
tains 5'M) c. c. of straw- col (jred fluid and a ([uantity of offensive gas, tlie Inng being 
(Mnni)n.'ssed; strong ])l«Miral adln^sions at apex; right pleural cavity contains no 
fluid. iHMTig entirely obliterated by i)ulnionary adhesions; the left pleural cavitr 
also contains a large (luantity of offensive gas. the lung Ijeing retracted. Peri- 
cardial cavity contains 100 c. v. of clear fluid. Heart: Weight. 255 grams; slightly 
smaller than nc^niial. flabby, an<l ])al(': the valves were comix»tent: interventric- 
ular fat somewhat increawMl: no sclerosis. Lungs; Left, weight. 1150 grams; con- 
solidated thnmghout: sinks in water; several <-avities. from the size of a cherry 
to tliar of a lemon, in superior l<»b s; lung much i»igment<fd. and made np almost 
entiri'ly of tubercles. Right lung, weight. 1.050 grams; surfsurecoverecl bynumy 
old adhesions; ajH'.x solidifle<l; disseminat4Ml tiilM'ndesand tubercular foci thixnigfa- 
out lung; cavity size of a cherry in ai)ex; lung floats. Liver: Weight, 1,690 gmns; 



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192 MABINE-HOSPITAL 8EBVI0E. 

A. P.: ago, 4."); nativity, Ohio; admitted to United States Marine Hospital. 
Fort, Stanton. N. Max., March 8. 1900: died Sept^^mber 29, 1900. 

Hiatort/ (contlcntied fram clinical itoicH of medical officer in command at St. 
Ijouis, Mo,). — Admitted February 17, 1900. Family history negative. Preaent 
Kickncss lH*gan about nine weeks ago with soreness in diaphragm on pressure and 
on walking. Cough developed, rapidly getting worse. Dyspnwa. weakness, lo6S 
of weight, little exiwictoration. anorexia, and l)owels irregular. Two chills ten 
we<?ks ago. Increased vocal fremitus on right side: respiration at right apex 
slightly rr)Ugh and jerky. Apex lx*at diffused. Smooth systolic inurmnr present 
Pulse high t+?nsion. Apparently a small hernia on right side of abdomen. The 
sputum containcxl many pneumococci, and later tubercle bacilli. Transferred to 
Fort Stanton. 

W. G.Si 

Condition as note<l on arrival at Fort Stanton was as follows: Body fairly wdl 
nourished; right side somewhat depressed: tumor to right of umbilicus, with vari- 
cose veins. Palpation: Vocal fremitus over right ai)ex; abdominal tumor gives 
impulse on coughing. Percussion: Pitch of right lung highest: spleen enlarged. 
Auscultation: IBronchial rales over both lungs: cog-wheel respiration: Tocalieso- 
nance str< )nger in right lung sui)eriorly . Heart: No mummr detected : apparently 
normal in all respects; jmlse rapid. Sputum showed a few tubercle bac&li. Un- 
nalysis negative. Gave a histx^ry of malaria, rheumatism, and alcoholison, hoi 
concealed his having had syijhilis. which was revealed during the necropsy. His 
lung symptoms rapidly improved, but the liver and spleen began to enlarge oon- 
sidenibly, and, together with several malarial attacks and one very severe attack 
of articular rheumatism, his physical c<mdition became very poor. A lond mitnl 
murmur developed in the course of the rheumatic seizure. The notes from St 
Louis mentioned a " smooth s^^stolic murmur,- ' but it was not detected here on 
his arrival . Several days i)rior to death acute nephritis suddenly developed, faring' 
ing alK)ut the fatal termination September 29. The urine during this uttter time 
was B<rant and loaded with albumin and casts. 

yrcropsy {fircuty-four Jnturtf aftei' death). — Inspection of body: Cadaveric 
rigidity and i)ost-mortem lividity well marked; face and body bloated and sanie- 
what cyanotic. Calvarium not removed. Thorax: Several enlarged glands bi 
the anterior mediastinum. Layers of pleurae adherent to pericardinm on left 
side and to diaphragm on right. Visceral and x>arietal layers partially adherent 
in phices. The lungs cac:h contained scattered tubercles, most marked in the 
right apex, which was in a pneumonic condition. Many healed areas of scar tis- 
sue were present. The lungs were somewhat congested and the Inronchi contained 
fn)thy matter. Heart umch enlarged, and mitral and aortic valves incompetent 
to the wat«»r test. Masses of vegetations on mitral valve and in the aOTte, 
causing stenosis: one leaflet of the jiortic valve destroyed by vegetations. 
Pericardium thickened and contained a small amount of serous fluid, par- 
tially adherent to left pleura.'^ Abdomen: Omentum normal. Spleen enlazged 
and contained several large gummata, also a wide liand of connective tiarae 
coTistricting its middle: adhesion to tail of pancreas and left saprarenal cap- 
sule. Kidneys swollen and capsules tense, but not adherent. Consideimus 
congestion of cr)rtex and medulla; also several well-marked gnmmata in each 
organ. Right suprarenal in normal condition: left eidargecl and adherent to tiD 
of ^wincreas. Urinary l)ladder. organs of generation, rectum, and dnodennm in 
normal condition. Stomach dilated and contained undigested food. Gall dncts 
normal. Liver much (enlarged and in state of hyx)ertrophic cirrhosis: sevenl 
large gummata j)resent. Tail of the ])an(!reas adh(»rent to spleen and left sapra- 
renal <'ai)sule. The mesentery, small intestines, large intestines, and the great 
vessels normal. Atrophv of alxlominal muscles on right side. 

C. R. 
J. O. C. 

W. R.; age, M."i: iiativitv, Illinois: admitted to United States Marine Hospital, 
Fort Stanton. N. Mex., Fr'bruary 14. IIMM): died C>;tul>er J»00. 

///.k/o/v/ irninlriisrii frtmi clinical notrs of iiirdicfd officer in command at St. 
Louis. Mn. ). — Family history n(*gjitiv(^ Personal history: Pneimionia in left side 
in iss-t; also malaria. Sy])hilis in \^h(\. Chancroids t\vice. Present gi**ViM<a 
lH>gan in June of 1 si»i), from exjyosure to storm. Caught a heavy cold, and has had 
slight cough and exp(K't^)r}ition ever since. Admitted to Marine Hospital, St 
Louis, Mo. . D»Meml)er 5, 1H<.)9. Anaemic appearance, flat chest, dyspncsa, " 

'>Thcf?retit voss4*1h. iktvc trunks, aud diaphragm normal, except that the pHaund 
the latter woru iMirtly adhereut. 



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194 MARINE-HOSPITAL SERVICE. 

right ventricle empty: thicknoss of wall, 7 mm.: left ventricle contains dark 
clots: valvert normal: thicrknes^s ot wall, Ik cm. Right Inng: Weight. 1 ,-1 10 granu; 
measurements. *^*0 l)y 22 hy 8 cm.: color, reddish slate; tissne crepitant; unmerow 
small tiiliercles present throughout the whole lung: no evidence of the tissue having 
broken down , nor does any pus exude on set'tion. Left lung: Weight, 1 ,(K>.j graiiu; 
measurements, 22 hy 18 by <$ cm.; condition the same as the right Inng. Spleen: 
Weight, 440 grams; measurements, 1(> by 12 by 5.5 cm.: pulp very soft: color, red- 
dish browTi. Left kidney: Weight, 280 grams*: cortical portion 7 cm. thick; color 
pale re<l. Right kidney: Weight. 220 grams; measurements, 14 by 9 by 4 cm.; 
cortical iK)rtion of a yello\N'ish-red color, the yellow being in six)t8 and streaks 
thickness of cortical portion, 1 cm. The walls of the lower part of the ileum are 
filled ^vith small tu]x?rcles. One round ulcer is present in the ileum, alK>at 2.5 cm. 
from the mesenteric attachment and al>out 10 cm. from the ca»ciim; this uker 
has heale<l: it involves the muscnilar layer of the intestines only, the floor being 
formed bv the i)eritoneal covering. This ulcer was about 1.5 cm. in diameter. 
Some of the mesenteric glands are indurated. Liver: Weight, 1,934 gn^ms; meas- 
urements. 151 bv 22 bv 7 cm.; color on section of tissue reddish brown. 

W. G. S. 

K. H.: age, 27 years: nativitv. Sweden: admitted to United States Mftrine 
Hospital, Fort Stanton, N. Mex.,'Novenil)or 21, 18Jrt); died Augnst 6, 1900. 

Ilistnrij {fak'rn from cliniml m)tcsoff/ii' invilival ojjicer in eomnmitd^ WUmina- 
fan, y. (.\). — Family history negative. lias had malaria and scarlet and yel- 
low fevers as a child. Pr(?sent attack began three years ago, after exposure to 
cold; bronchitis developed, and since then he has had a constant congh, varyinp 
in intensity, constantly losing weight. Has night sweats at rare intarvabu 
Examination of chest: Bronchijil breathing at both apices. Since admission to 
hospital there was at first marked improvement, but gradnaUy the symptomi 
returned with increaserl severity, cough l)ecame worse, night swtfats more fre- 
quent, dullness on percussion more marked; patient complaining of a dull pain* 
varying in int(^nsity, first on one side and then on the other. 

Ajfril .7, ifio'). — The lungs were again examined, and showed increased rougheDed 
breathing at iMith apices: dullness more marked. Examination of spatnm failed 
to reveal the tul)ercle Imcilli. For five months past imtient has been slowly grow- 
ing worse, sometimes api)earing much improved, but this succeeded by retami 
of the distressing symptoms. There has been no great loss in weight, and at the 
same time there has Ixxm little t^r no gain. The treatment thronghont has con- 
sisted chiefly of cod-liver oH and creosote, with such symptomatic treatment aswai 
netressiiry. Present conditii^i: Has large dei)osit of tulierculons tissue in apex of 
left lung, and in i^osterior i)art of lower IoIk' on left side. There is consideTaUe 
pleurisy at the ajM'x. The nght ai)ex is also affected. 

yorriiibcr Ji. isoff. — Weight, 121.2.") j^ounds. Inspection: Limited respizatioii 
on left sidt?. Slight depression al)out .*> cm. l)elow left clavicle. PiupatioB: 
Vocal fremitus increaw'd over ujiper jiart of left lung posteriorly. Anacnitatioii: 
Numerous rtiles heard over entire left lung and over nght lung to third or foartt 
rib: rales most marked in left apex and just below left clavicle. Reflpixmtks 
normal in right lung l>elow third rib. Heart: Pulmonarjr second sonnd mock 
accentuated: otherwise heart is normal as regards xx)sition, size, and valTBi; 
pulse rapid. Sputum: Tul)ercle l)a('illi found in great numbers. 

Fvhnmnj j^. — Dullness in right a])ex also: rales same in both Inngs as at pre vk wi 
examination, butiiow have a more i)ronounced clicking sound; dnlhiess m lower 
part of left lung ])osteriorly from lower margin of thorax for alx)nt 7.5 cm. above. 
(.'omplains of giirjrling during res])iration in middh? lolx) of right Inng. The 
j)aHent continui'd to have high temperatures, but even then he was always chee^ 
ful an<l hoi>«*ful of recover^'. His api)etite was fairly gotxl most of the time. 

r)rrrinfnr /.v, — F*at i ell t ^\•Jis given another jiliysical examination and the leafioB 
seenK'd to l»e s])r»»;iding,and lK>th lungs showed* foci of infection thronghont. The 
latter i)art of ^larcli th«Ti» was a marked improvement, and he was moved into a 
general ward. A few days after. he c(>iitra(rted tul)ercular pneumonia and nearir 
died. TI(.' gradually aiid slowly went down after this. The hemoglobin remaiiiM 
clow to 7") per cent, and the blood count at l.OOO.ooo until a few weeks befoveUa 
death, and then ran down rapidly. He r«.'Si>onded nicely at all times to the dlaio 
reaction. Had several slight hemorrhages from time to time: also had then 
iK'fon? coming here. He died from exhaustion. 

yrrrnftsj/ {lliirtrrn hmirs a/frr (hath). — Ti<-Mly very much emaciated. Rigor 
mortis well marked. Skin yellowish; no Ix'dsores. The thorax examined in the 
usual maimer. The pleura?* and i)ericardium were firmly adherent to the anterior 



VAKISfK-iliiSIMTAl. SKKVUK. lUfi 

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MARINE-HOSPTTAI, SEBVICE. 



ENTERIC Ft:VBR. 



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I' nf hirgn.r, iii-tife vnfarrhal. 



J. D.; (it[0. ■(*! vcars: niitivitv, KwiHlcn: iicluilhtl tn Unitoil States Marine Hot' 
pititl. port iif Sun Franrijuvi. ChI., JimnEtrj-ai), limi; dieil May 3«. llMil. 

Ilintiirji. — Un <>nt<>Hiit( imticiit cciiupluiiipd of jMin in tho ubdmnen. nccatiiiwil 
i-hillx, ami inulrility ti> fat. IJowcIh rcffulsr. Exnmhmtion showed row- (ipots m 
ii}Hli>i]ii>n niKlliivvt-r tliiirax: inoilcruto tyiiipnnitfiH. TempH^ratnrp. 4tl.U C. Tlw 
rjiiiIiniiitesini-n>iw<il.m,-i»kin),'tholiviT(lTilliieM8. Thet^inperiitnrerpinainedhi^, 
Hilly l)fiti;i <'outr< illi'd liy iMitlin. Sonlew were prespnt. BijwpIs lit^aini' open.raor- 
iiiK tlirt<o or four tiiiiiv< u iluy. In thomH^iindwi^ek patient iH-ciLiucttoiunoient.the 
lioHTt'x Hi^tion Ittiramc- rtipi'l. th« tmrniilH lH-ing mnmed. At this timo appesTcd ■ 
fliftht liHoking conRli. 'Oii' dias!" n-actioii was present in tho nrine. At the eod 
of thn Keomd wo«k ru:liyiuiM<'H npixiared on the scrotuin and thiKhs, and a pnni- 
Init diHcharKt' ''ime from tho left i«r. TlicHiKns cleared up, with tlippsceptionof 
the fontrh and a ntpid, V)W-ti'niiiim imlse. TliehearinK lieeauie hettvr and the ft 
cimilition iiniirnvMl. Piiticnt diwliarKwl, recovcrpil from enteric fever, Aiiril II, 
ii'id n>ailmitte<l for lumtu oitarrlial infliuunuitiun of larynx, utncons uiembnuw. 
Aiiril Vi. Till; ]>ati(nit iinprnved iindtfr inhalation treahiicnt. the tempenitnre 
Ixv-ominft iir.rnial iind lin»itliln){ enMer, thoURh irritation of the larynx and tomI 
I'lirds wii.-* still present. May 1 7. wvere attack cif dyspnii'a and curdini? fikilmt 
thniitiucd. luijirovt'd until May 30, whin he died iroddenly of heart failoreia 
siiite iif activi- stiinnlativc trenttnejit. 

Tiiiilmriil, — C In ndmiiwioii for thn first time iMitient was pven a gentle nwriM- 
rial iiiirRit Willi ammatii-s for two days, when treutment by uieauB i>t mid balhi, 
wliisKy, and stiyi'hninu was inslitntml. The other treatment was Incal, listerint 
fur the jnonth, lmri»;-afid wJntitm to wash ont the ear. laxatives and Ktiuitdantt 
an iikdiiitti-d. As tht> i-nti-riit symptoms snlisided tonics — ddorido of inm anl 
Fowler's wilntion of »r«.flii<^— were jdvi-n, altermitiiig witli iiainine. At the ttn 
of thi< tirKt iliHchiinci' i>atii>nt was on potasninm Imlidu and protoiodidti of uiermn 
pills. Ill- wai iilsri rec«iviuK a i-onjfh mixtnre containine morphine sulphate aoi 
uminoninni chlciriili'. Dnring the mt-iind iwriod tr<.<atjueiit was i-outinued wilk 
thearlditioTiof ali.-ntover l>ed connected with a steam ketUc for tfivinK inhalalia 
nf turi)entine vapor. At the time of death patient was on potasainm jodldr, 
Lar;;i> doHcs of Hieohol and strj-ehiiino were given in the hope of snpportiiig 0» 
heart , hat all efforts were nuavailinf,'. 




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190 MARINE-HOSPITAL SKRVICE. 

weight, 415 grams: dimeiiRions. 22 by ]H by 5 cm.: slato color: crepitant thrrmgh- 
o\it: bloody fleniin oxndes from cut surfiu-e on pressure. Left Inng: Pleura 
adherent over whole surface of lung, so it is impossible to remove the organ with- 
out tearing it to pieces: tissue of organ mon^ dens<» than right liuig and has the 
appeiirance of partial consolidation: blo(xl and s(»mm exude from cut surface. 
Spleen: Adherent: enlarged; weight. 405 grjims: dimensions. 14 by 5 by H) cm: 
two accessory spleens near hilum. The organ is retldish brown in color, very finn 
consistency, and is cut with diffi(;ulty. Left kidney: Weight. 2(M) j^rams: dimen- 
sions, 13 by 8 by 3 cm. : pale yellowish-brown color. Cortex 1.5 cm. thick; Htre«iked 
with yellowish lines and many yellow spots the. size of a pin head: tissue tinu: 
pyramids normal in size: much fat in pelvis. Right kidney: Weight. *J<X1 grami*: 
dimensicms, 12 by 8 l)y Jl.5 cm.: appearance pn^cisely the sjime as the left kidney. 
Stomatrh 1(5 by f.5 cm.; contains yellowish fluid in small (piantity ha\ing the 
odor of brandy: i>ancreas normal. Ascending colon bound to the right Idilney 
and to the iliac fossa by dense adhesions: sigirioid flexure lx)und down to the ci*a- 
cum; probe from the woun<l in right groin passes into an alx^ess cavity about the 
size of a walnut beneath ceacxmi. Only tin* i)r« >ximal end of the appendix can be 
identified. The lumen is clo8e<l. Lower part of small intestines is full <»f dark 
brown fluid: areas of induration 1 by 5 cm. in the small intestine, just alx>ve the 
ilioctiecal valve: thev run transverse to the long axis of the intestine, small p<3int« 
of hemorrhage on tfiese areas. Ceaciim distinctly indunit<.*<l , small ulcers with 
hard margins in ceac^um. and lower 2 inches of tistrending colon. Mesenteric 
glands enlarged. Liver: Weight, 1 ,0H1 grams: dimensions, 22 by 15 by cm.; dau-k 
cluKrolate color on surface: d(?ei) rcMl-brown color on cut section; tissue firm and 
dense. 

W. Q. S. 

C. J.: age, 37 years: nativity. Norway: was admitt<o<l to the United States 
Marine Hospital. i>ort of San Francisco, Cal.. July 2. IJHM). and died Au$^st 7, 190U. 

HiMorf/. — Family history negative. Patient entered hospital complaining of a 
cough which had resisted medication for alK>ut three months; also coiuplained of 
I»aralysis of right side of face, and adisc^harge from right ear. Expectoration was 
profuse and purulent. Patient's voice was very hoarse, his throat pained him, 
and he found it very difficult to talk. Examination showed coiLSolidation over 
left lung nearly to ])ase, and c<msolidation of right ai)ex to about the third rib. 
There were cn»pitations all over right apex, and bronchial breathing over npper 
I)art of right lung. Tubt?rcle bacilli were di.s<^'<>vere<l in the sputum on July 5, 
UIOO. Patient gra<lually lost weight, cough and expectoration l)ecame worse, and 
his puLsc iKM'ame very weak. On August 5 the pulse was very rapid and feeble, 
pulst^ rate l>eing 130. with great dyspnoea, feet and hands were qoite cH)ld,and 
some (edema of feet. Thcr<.» was extreme tenderness over left side of cheet 
Examination showed dullness anteriorly ov(»r ai>ex of right lung down to third 
rib. In b-f t ajH'x a cavity was r vident. On auscultation, anteriorly, loud bronchial 
breathing and cre])itation was heard over entire right lung. Egophony heard 
over left ajH-x and almost entire absence of breath sounds. 

Aiifjiisf /.— Patient failing rapidly, extreine dyspnrea, pulse very rapid and 
feeble, later in afterncHm Inn^ame unconscious and died. 

Treatment at first consi-tf^l of cn»osoti? and oil. maltine and whisky. This was 
soon a)>andoned, and his strength was maintained by a nourishing diet, whidsy 
and strychnine. His right eye was wa.shed twice daily ^^ith a solution of boric 
acid, his (^ar was treated with jKjroxide of hydrogen, and a spray of Dobell's 
solution usi'd on his tliroat. 

AVcrr>/>K// {ehjhti'vn httnrs iiftt r r/c(/ ///).— The lK)dy is that of a iMK>rly nourished 
white adult male. Post-mort<*m lividity is slight: rigor mortis well marked: fin- 
ger nails blue, and (edema of feet and legs. Abdominal ca\'ity: Serous fluid not 
increased and no great discoloration of contents. C'liest: Left pleural cavity con- 
tains r)tM) c. c. of straw-colored fiuid and a quantity of offtrnsive gas, the lung being 
compresseil: strong pleural adhcsi(»ns at ai)ex: right ])h*ural cavity contains no 
fiuid. being nn tin 'ly obliterated by pubnonary a<llie.sions: the left pleural cavity 
also contains a large (luantity <)f offensive gas. tlie lung Ixjing retracte«l. P^- 
cardial cavity contains 100 c. c. of clear fluid. Heart: Weight, 2or> grams; slightly 
smaller than normal. fial>by, and pal(?: the valves were comi)etent: interventric- 
ular fat Hmiewhat incn;a.»4t*d: no sclerosis. Liings; Left, weight. 050 grams; am- 
.solidati'd throughout: sinks in water: several <avities. from the size of a cherry 
to that of a lemon, in snjH*rior Inb.s: lung much idgmented. and made xxn almost 
entirely of tu))ercles. Right lung, weight. l.o."»o grams: surface covere<l uy many 
old adhesions: aiM»xsolidifierl; disseminated tnlnTcles and tubercular foci tlirongh- 
out lung; cavity size of a cherry in aix?x: lung iluits. Liver: Weight, 1,680 gnUDs; 



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192 MARINE-HOSPITAL SEBVIOB. 

A. P.: age, 4."); nativity, Ohio; admitted to United States Marine Hospital, 
Fort SUinton, N. Mex., Mart-h 8. IIKK): dieil Septeml)er 29. 1900. 

Histori/ icoHfJciisi'fl fnnn clinical iiofcs of mat leal officer in command at Si. 
Dtnis, M(t.). — Admitted February 17,1900. Family history negative. Present 
sickness ]H>gan about nine weeks ago \vith soreness in diaphragm on pressnre and 
on walking. C'ough develoiKjd. rapidly getting worse. Dysimrjea. weakness, low 
of weight, little exinxitoration. anorexia, and lK>wels irregular. Two chills ten 
weeks ago. Increased vocal fremitus on right side: respiration at right apex 
slightly r(mgh and jerky. Ajiex Inuit diffused. Smooth systolic muruinr present 
Pulse high tension. Api)arently a small hernia on right side of abdomen. 7bt 
sputum (^onttiintHl many pneumococci, and later tubercle l>acilli. Transferred tD 
Fort Stanton. 

W. G.S. 

Condition Jis noted on arrival at Fort Stanton was as follows: Body fairly wdl 
nourished: right side somewhat depressed; tumor to right of umbilicus, with vari- 
cose; veins. Palpation: Vocal fremitus over right apex; abdominal tumor gives 
impulse on coughing. Percussion: Pitch of right lung high&st: spleen enlarged. 
Auscultation: Bronchial rales over both lungs: cog-wheel respiration; vocal reso- 
nance stronger in right lung BUi>eriorly. Heart: No murmur detec't^d : apparentlj 
normal in all resi)ects; pulse rapid. Sputum showed a few tubercle Imcilii. Un- 
ualysis negative, (^ave a history of malaria, rheumatism, and alcoholism, biU 
(!oncealcd his having had syi)hilis, w^hich was revealed during the necropsy. His 
lung symptoms rapidly improved, but the liver and spleen began to enlaiige con- 
siderably, and, together with several malarial attacks and one very severe attack 
of articular rheumatism, his physical condition became very "poor, A lond mitral 
murmur developed in the course of the rheumatic seizure. The notes from St 
Louis mentioned a '' smooth systolic murmur," but it was not detected here on 
his arrival. Several days prior to death acute nephritis suddenly developed, bring- 
ing alH)nt the fatal termination September 29. The urine during this &tter time 
was scant and loaded with albmnin and casts. 

I\'c('rnj)sy {fircnfy-foiif hours after death). — Inspection of body: Cadaveric 
rigidity and ])ost-moriem lividity well marked; face and body bloated and sooie- 
what cyanotic. Calvarium not removed. Thorax: Several enlarged glands b 
the anterior mediastinum. Layers of pleune adherent to pericardinm on idft 
side and to diaphragm on right. Visceral and x)arietal layers partially adherent 
in places. The lungs each contained scattered tubercles, most mar Red in the 
right apex, which was in a pneumonic condition. Many healed areas of scar tis- 
sue were pres^'ut. The lungs were somewhat congested and the bronchi contained 
frothy matter. Heart much enlarged, and mitral and aortic valves incompetent 
to tlie water test. Masses of vegetations on mitral valve and in the aortSf 
causing Fteiiosis: one leaflet of the aortic valve destroyed by vegetations. 
Pericardium thickened atid contained a small amount of serous miid, par- 
tially adherent to left pleura." Al>domen: Omentum normal. Spleen enlarged 
and cont^dned several large giimmata. also a wide Imnd of connectave tinne 
constricting its middle; adhesion t^) tail of pancreas and left suprarenal cap 
Kule. Kidneys swollen and (!apsules t(*nse, but not adherent. ConsideraUe 
coTigestion of cortex and me<lulla; also several well-nuirked gummata in each 
organ. Right su])rarenal in normal condition; lef t enlargoil and adherent to tail 
of |>iincreas. Urinary bladder, organs of generation, rectum, and dnodennro in 
normal condition. Stonimli dilated and contained undigested food. Gall dnds 
normal. ]iiv<T much enlarged and in state of hypertrophic cirrhosis; several 
large guninuita ])rfsent. Tail of the panc.n^*^s adherent to spleen and left sapra- 
renal capsule. The mesenti»ry. small intestim?s. large intestines, and the great 
vessels normal. Atrophv of abdominal muscles on right side. 

C. R. 

J. O. C. 

W. R.: age. .^o; nativity, Illinois: admitted to United States Marine Hospital, 
Fori. St ant on. N. Mcx., February 14. 11)00; died October G, 1900. 

Ilisffn-i/ uutmhiisdl fnnn r/iiiiraJ nttirs o/ innlical officer in command at St. 
Lniiis. ,l/o, ).— Family history negative. Personal historj': Pneumonia in left Bide 
in iss-t: also malaria. Syphilis in \><Si). (.-hancroids twice. Prt^sent sickneai 
Ixfgan in June of 1 8U0. from exposure to storm. Caught a heavy cold, and has had 
slight cough and exp(H't^)ration ever sinc<». Admitted to Marine Hospital, St 
Louis, Mo.. l>*ceml>er o. i.soo. Anjemic api)earance. flat chest, dyspnoea, 

"Tho^reat vesHeK iu*rv(.' trunkH, and diaphragm normal, except that the ploniml 
the latter vrvm jwirtly odhcivnt. 



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194 MARINE-HOSPITAL SKRVICK. 

right ventricle empty; thicknoss of wall, 7 mm.: left ventricle contains dark 
clots; val vt\s nonnal ; "thickness of wall. 1 i cm. Rij^fht lung: Weight, 1 .4 1 grains: 
measurements. 2(5 by 2*J by 8 cm.: color, reddish slaUs tissue crepitant; iiumeroiu 
small tulH?rcles i)resen t thrtjughout the whole lung; no evidence of the tissue having 
broken down, nor d(X'8 any pus exude on set^tion. Left lung: Weight, 1 ,0()5 gramfi: 
measurements, 22 by 18 liy (> cm.; condition the same as the right lung. Spleen: 
Weight, 440 grams; measurements, 16 by 12 by 5..") cm.: pulp very soft: color, red- 
dish brown. Left kidney: Weight, 230 grams: cortical i)ortion 7 cm. thick; color 
pale n^d. Right kidney*: Weight. 220 grams; measurements, 14 by 9 by 4 cm.: 
cortical portion of a yellowish-re<l color, the yellow l>eing in spots and strealu; 
thickness of cortical i)ortion, 1 cm. The walls of the lower part of the ilnnmarB 
fille<l with small tnlHjrcles. One round ulcer is present in the ileum, about 2.5 cm. 
from the mesenteric attAchment and about 10 cm. from the caH.niin: this ulcer 
has lieale<l; it involves the muscular layer of the intestines only, the Aoor being 
formed by the peritoneal covering. This ulc^r was a]x)ut 1.5 cm. in diameter. 
Some of thv mesenteric glands are indiirated. Liver: Weight, 1 ,034 grani.s; meas- 
urements, 31 bv 22 bv 7 cm.: color on section of tissue reddish brown, 

W. G. S. 

K. H.; age, 27 years; nativitv, Sweden: admitted to United States Marine 
Hospital, Fort Sbmton, N. Mex..*Novem]>er 21, l-Syi); died August 0, IIKM). 

Ili'itfor// (taken fvom rl in Uuil in)frsofthr nnuh'ral ajjiceriii coimnftitd, HV/iHiHtf- 
/(>/^ y. ('.). — Family history negative. Has had malaria and scarlet and yel- 
low fevers as a child. Present attack began three years ago, after exxKMYire to 
cold: bronchitis develope<l. and since then he lias had a constant congh, YKTjinf 
in intensity, c(mstantly losing weight. Has night sweats at rare intervak. 
pjxamination of chest; Bronchial breathing at both apices. Since admisRum to 
hospital there was at first marked improvement, but gradually the symptomi 
retumerl with increased severity, cough became worse, night sweats more fir** 
quent, dullness on x)ercussion more marked: x)atient complaining of a dnll pain, 
varj-ing in intensity, first on one side and then on the other. 

x\pril .5, itniif. — Tlie lungs were again examined, and showed increased ronghfiiud 
breathing at lM)th apic(;s: diillness more marked. Examination of spatnm foiled 
to reve^d the tul)ercle bacilli. For fiv(> months past iKitient has lx»en slowly grow- 
ing worse, sometimes api)earing much improveil, but this succeeded by retnrm 
of the distressing symi)toms. There has l)een no greiit loss in weight, aiid at the 
same tinif* there has lx>en little or no gain. The treatment throughout has con- 
sist<Hl chiefly of <!(Ml-liveroil andcreos<^te. with sucrh symptomatic treatment asww 
necessjiry. Present condition: Htus large dejiosit of tuberculous tissue in apex ol 
left lung, and in i)osterior i)art of lower lobe on left side. There is consideraUe 
pleurisy at the ajwx. The right ai>ex is also afftH-ted. 

Xomnhcr J/, fsffft. — Weight. 121. 2.") jMrnnds. Insjwction: Limite<l respiratioa 
on left side. Slight depression alniut ."> cm. l>elow left clavicle. Pupatioii: 
Vocal fremitus incr(?ased over ui)i>er j^art of left lung i>osteriorly. Auacmtation: 
Numerous rales heard over entire left lung and over right lung to third or fonrtfc 
rib: n'des most marked in left a])ex and just Ix^low left clavicle. Respiration 
nonnal in right lung Ix'lnw third rib. Heart: Pulmonary se<»nd sonna mvdi 
ac^'entuated; otherwise heart is nonnal as regards ix>sition, size, and valTfli; 
inilse rapid. Sputum: TulK>rele bacilli found in great numbers. 

Fihnniri/ J J*. —Dullness in right apt^x also; rales s;ime in both lungs as at previoos 
examination, but now have a more ]>ronounced clicking sound; dullness in lower 
part of left lung posteriorly from lower margin of thorax for alK)ut 7.5 cm. above. 
('oniplains of gurgling during respirjition in middle lo})e of right long. The 
IMitient continued to have high ti'uiiHTatnres, but even then he was always cheer 
ful and hoiM'ful of reeovery. His appetite was fairly go<)«l most of the time. 

Drrtinhri' /.v. -Patient \\'as given another iihysical examination and the leoflD 
seenu'd to ])o spreading, and l»otli lungs sliow«'d foci of infect ion throughont. The 
latter ])art of March tht-re was a marked improvement, and he was moved intoi 
generjil ward. A few days after, he contracted tubercular pneumonia and nearly 
die<l. H»' gra<lually and slowly went down after tliis. The hemogloHn remained 
clow to 7.*> ]H'r cent, and the blood count at l.ooD.ooo until a few weeks befaz6liii 
death, and then ran down rapidly. He responded nicely at all times to the diaio 
reaction. Had s«'veral slight liemorrhagts from time to time: also had tiMOi 
iM'fore coming here. He died from exhaustion. 

yrrropstf (fliirtrrn ht>tn-s a/ft r (frath). — licwly very much eiUilciated. RigOT 
mortis well mark«H^l. Skin yellowish; no l>t'dsf»res. The thorax examined in the 
usual manner. The pleura* and pericardium were lirmly adherent to the anterior 



1lARt?rR-Hi>S|'IT\l. SKKVIi F. ]M 



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HARIHE-HOSFITAL SERVICE. 



ENTERIC^ FEVER. 



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J. D.; iiKC, 4ti vi'Hrs; nativity. Swi'ilpn; iiiliuittiHl \ii United Statps Marine Hw- 
Itital. port of Sun FrantlHt-o. Cal., Jannary 23, llWl: diivl M«y 2«, li«)l. 

Hintiirff. — ()n entoriiiK imtient rnmplHined of pain in tbo abdomen. iKcasioai) 
<^hillH. and iniibility to eiit. Bowi-lx tvgulnr. Exnuiiniitirm showed row- Hpots la 
iiiHioiuvu anil lower tborax: moderate tynipiinites. Teini>eratnre. 40.IJ C. Tin 
IjitLiKLiiitetiincntiitied.iuaHliinK the liver dnIliipM. Theteinperntnrereiuninedlii^, 
1 inly iH'in^ controlled liybHtlw. Sonleswcro prewcnt. Bi>welal>ecameopen,inoT- 
intc tliryoor four tiiuex h day. In tin- Hi-cond week itatient iM'c.iuiti somnolent, tta 
liT<art'H Hction liecamc ninid, thesonndn )>cin(( nmfned. At thiH time appeoitd ■ 
HliKlit liackinK eolith. Xh<- diaxo reaetion tvan preHent in the urine. At the end 
iif thtt second wcuk i^chymoW's appeared on tho scrotum and tlilKhs, and a puru- 
lent diHchar{H> came fmnttlii' left ear. Tlic Hijfns cleared up, with thoeiceptiimrf 
thecoii^h and a rapid, low-ti.-nsiou pnlue. TheheariwK Iwcauoltettcrand themr 
condition improveil. Patient diwliiirKed, rw^overeil from enteric fever, April 11, 
ami readmitted for acute catnrrhiil inflMnmittiou of lar.vux. inncous membrane, 
Al>ril 1^'. The ]i)Ltient improved nnder inhalation treatment, the temperatnn 
liecoinintc ii'irtiuil and lireattiiTi;; mimiit, thooKh irritatiin of the larynx and vonl 
(itnliWiiK still prewnt. May IT. wvere attack of dyapnipu and cardiac fiulnn 
threatened. Improved nntil May 20, when he died saddenly of heart failniein 
apite of active ntlmnlative treatmi-nt, 

Triiifmrtit. — (>n adiiiiwicm fcir the flrKt time i>atient watt given a }^ntle mem- 
rial Iinri^- with aroniiitien for two days, when treatment 1)y means of cold h^l, 
whixky, and Ktryclmine wafl inittitntiHl, The other treatment was local, liatenne 
for the mriiith, iHiric-aeid Kolntion to wash ont the ear, laxativeo and stimnluti 
aH indicated. Ah the enteric Hymptomx Hnlixidpd tonicM— chloride of inm aid 
Fowler'x Holution of ar.'ieiiic — were tnv<m. alt«nmtlnK with qniuine. At the tin* 



ammoninm chloride. During the second jieriod treatment was t^ntinnedwitt 
theodditiimof a tent over Iwti comiectedwitha ateam kettle for t(i\-inK inhablici 
of tiirjientiiiu va])or. At the time of death ])atient was cm jKitasninm iodldb 
Ijar^iedoMcsof iLl(«>hnl and strj'chnino were given in the hope of flappotting tte 
heart, bnt all offortM were unavailing!. 




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i;. .<. Marhii- I^•^4>iIal, f«rl of .-Niti Fniiii'ln-.i. |-n1. 




XiviiiiHn/ (finiif ii-tini hiiitiv ufltr il,-<itli).— 'nw\Mx\y ia t\Mt'it a uiOM-iaat uAalt 
n'hito mull'. iiini'Ii eniooiiitnl, iiml witli ii 1iiTKi< nkt^Wal i1''re1<iiiia«iit. Height. 
l.TTo iiictcTK: ri(!iir mort^K lirt'si-iit: siigKiliitioHa luit well iimrkt-il. Braili. UM 
gnanH weight. Diini iiiiitiT iiilU<-n-iit iitiil {'in)K<Titfil. Rifflit luufc, 4SII gnuiu 
weight: flofiU-<l in watiT. Left Iuhk. t'lt ffriima weiglit: flouteil In u-ater; sl^bt 
a(lhefiii>ii at ii)«x. Porlcurciiniii nnmiiil: tinKni' nf tfrent vessclH infiltrated with 
fiit. Heart. '-I'M (Trains wcdftlit. Musc'li- of left vt-ntrick- mncli luiler tham ri^t 
aud itiHItnittHl with fat. Valvi-H ni)nnal Jii &i>)N^irai)ce said ooiiiin-tent bf the 
hyilroHtatii^ tewt. Livi-r, l,7i!0 ktoiiis wi'iuht; cimKestwl. Spleen SIK graiu 
wHgbt: ciini^estiil and friable. Stomiu-h ixiruiul. Ljirge intesttue KOWiHated, 
rngip (ihlitt'nittHl; wallK cunt^-Mtt'il. thin in Kt><)tfl. anil aiUwrent, pivseiitiiig all 
KTti'les of bi-iili'(l iilcen. Siiuill intestine: The ili'iim »h<iwH many nealed nloera. 
KiiliieyH.-14()gn»nsweiKbt.<-i>m1>iiieil: coiiueBti'il. Liimj-.t: The vocal cords show 
fatty clmiixeH. There are uli-enitint; xnrfui-i'H in the liimyx which are bathf^in 
a thin inimlent Hnid. Othvr orgiui!* normal. 

J. N. F. 

C. W. V. 

J. H. a. 

Eiid-rif fn-iT, trifh iiiiitjiIitiilliniH. 

H.P.: age. :!4 yearn; nativity. Vinlanil: uilniittiil li> United States Murine Hos- 
pital, Stniileton, N. Y.. Mtirc-li';t. IINjl. 

l'irtililir<ili<'ii.—l.iiiht liair, gruy eyes. Initiiilr' II. E. P. and dato inrT tattooed 
on the li'ft hand. 

HiMt'irg. — Diffii-nlt to olitain with aci^urni-y, iifi i>ati«nt does not H})enk or nnder- 
Htand EnicUHh very wi-11 and iti in a Htupid (mndition na well. DnrinK the psfit 
nine nil nitliH hi« has Hix-nt innrh tinn' in hiMjiitalH. at Slnliile, BoHtdu, and Norfolk. 
Hnffi'ring *-ith rbinmatism. Siiys tliiit hiH iin-«-' '" ' ' '- 



ii-kn' ilnration. Imt tliat he himtiail 
ownrlt J'cirfivertiiyn. ('oiupliiinsfhii'llyof sliortm 



t illneiiK Ik of two c 



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.>;h fur a Inng tiini<. Hum lieen unable 
. f sliortni's«"f Iji 
rift I'liiinriT )><-\-iii yi-ars a^o. 



if liniith and i-ooitli. Only 



i<r/i'<ji.— I>jilii'nt fr^io'nts tliu aiiix'iinim'i' of U-ing Herionxly ill. in weak 
and very sliort of bniitli, an'l in menttUy dnll, ijkin is dn,-. the cbeeke flnshed. 
and tile pnlsi-, aItlii)Lif;]i of lairvolniix' and nvnhir. iu rajiid. Ovi-r the entire 
chi-nt theru in barnli breathing with sonor-oi]* and Kibilant riileH. and moist, bub- 
bling ri'ileii. Tbr- aiK'xof tbc'bi'itrt in ili»idiii'i«l dins'tly ibiwnward alxintaninch. 
and II bind nyslolic tiiuriiiiir ia audible. Tbi'm Ik nbght alKlominal tendemMW, 
th>! Hplii'n is enlargi-d to jHTi'nssion. and the lymiibatii; glands gener^ly are 
enlargiHl. Teiniieratnre. :tti. I. Xo alKlominnl distention ur gurgling. 

C'oiirm- iif ilixniiu: — C'lii-nt Myinptnuw tbe incist iirnminent; cxoeiwive eungh with 
thecjtiKftiiration of l)limii-«taln<il simtnin. IhiwelH active, the niovementa being 
flnid and yelbiw. H)mtnin <'ontainH tb>' dijilocoecns of puonmonia in aln ' 
oud other cued; tnbeivle bacilli not found. 



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202 MARINE-HOSPITAL SERVICE. 

Tnttfmrnf. -Stimulant thronjrhont, whisky and strychnine. I(v and alcohol 
luiths socnriMl slight ti'ni]>(>rary reduction of teniiieratnrc. Salol. PrwliKesirtl 
foods. 

uVrc/v>jAS// itu'rln' hoHrti iiftt^r drath). — Rigor mortis and i>08t-mort<*in li\iility 
present. Eyes glazed and thoir impils moderatt;ly and ecjually dilateil. Some 
dricil hlo<3d on the lijis and teeth. Brain firm: weighs 1,420 gram.s. No groas 
changt?s visible externally. PunctJi vascnlosii very plainly marked on cnt Hurface. 
On incising the alxlominal wall, the subcutaneous fat was found to be scanty. 
Skeletal muscles dark colored. No gross abnormalities of position of viscera 
noted. Pt»ricardium adherent throughout its serous surfaces, the adhesions being 
apparently of old formati(m. Heart weighs 880 grams. Both ventricles contain 
dark fluid lilood and ante-mortem clots, and both are mo<lerat«ly dilated. Mitral 
orifice admits three fingers to the second joint, tricusi)id orifice two. The valve 
flaps of the mitral and aortic valves are thickened, es])ecially the ixisterior mitral 
flap. MycK'ardium is of about normal thickness, of dark red color, and fairly firm. 
Left pleui-al sac^ is free from adliesions or unusual amount of fluid. Left lunjf 
w(jighs (U)0 grams. Apex of u])iK»r lobe is in a state of red hepatization, sinks in 
water, and is fria])le. The lower part is deeply congested, but floats and crepi- 
tates. There is an unusual amount of anthracotic deposit throughont the lung. 
Right pleunil mxc presents m'lny old adhesions. Right lung weighs 540 grams. 
floats. cn»pitates. and presents on cut section black pigmentary deposits. 
Mediastinal glands enlarged. Great vessels normal. Omentum contains oiUv 
very little fat. Spleen weighs 550 grams, is much enlarged, and its pulp is dari 
red and friable. Left kidney weighs 2*25 grams, capsule stripped easily, cut sur- 
face pale, but markings are distinct. Right kidney weighs 195 grams, and its cut 
surface is still paler than that of the left. Intestines generally distended. On 
oi)ening the ileum Peyer's patches were found swollen and injected and a few 
small <^nes were ulcerated. Stomach api)eared normal. Mesenteric Rlands much 
enlargc?d. Liver weighed 2.150 grams, and was abnormally frialde. Bladder 
empty and contracted. Pancreas ai)i)arentlv normal. 

G. W. S. 

Xrfr growth, malignanf, (jhnuluhtr vnn^noma, 

J. F.: age, 53 years: nativity. New York: wliite; admitted to the United States 
Marino Hospital, St. Louis. Mo.. Noveml)er 20, 1000, and died December 26, 1900. 

History. — Patient stated that he had had dyspepsia for two years, and that he 
had been feeling esx)ecially bad for the past six days. He complained of nansea 
and x)Hin in his stomach. He had eaten very little for two days, as he became sick 
soon after taking food m his stomach and usually vomited it. He said he had a 
chancre twenty years ago, whii^h was followed by an enlargement of the glands 
in the groin, sore throat, and an eruption on his body. 

Pht/sic(tl v.camiuafioii. — Cervical glands enlarged; slight dullness on percnssion 
over both liuigs: the respiratory sounds are roughened, but no rales are present 
A blowing murmur is heard over th<^ aj^x of the heart. A tumor is felt extend- 
ing from 1 inch 1h.?1(>w the xiphoid cartilage to the umbilicus. This tumor is hard 
and irregular in outlin(>. and the x>nlsations of the aorta are transmitted throngli 
it. The spleen is slightly enlargtid. The vomited matter is of a yellowish-green 
(■olor. and has an acid reaction; no free or combiu(>d hydrochloric acid is xireeent; 
n<» cells res<.»mbling cancer cells can 1)0 found by the microscope. On November 
ir», at 2.;}0 a. m. , the j»atient vomit^'d coffee-colored matter after an attack of severe 
]»ain. The (^ase was thought to 1^? one of cancer of the pylorus or dnodenam,and 
an f)iH^ration was advis<'d. bnt the patient would not consent. He continued to 
grow worse every day. living chi«'fly on buttermilk, malted milk. l)eer, etc., and 
when thesM were not retaine<l by the stomach he was fed by rectal enemata. He 
])e(^am(? gnatly emaciated, and died of exhaustion at 4 p. m. December 26, 1900. 

Nrrrnpsf/ it inutu hours (ift'f <'^'''//0.— Height 170 cm., alxlomen 1x)at shaped, 
alxlominal walls 0.5 cm. thick: the inus<Milar tissue is of a bright ri^d color, stomach 
greatly dilated: gall bladder full: a larg<'. hard swelling is present in the epigas- 
tric region. Hrain: Weight. 1.^550 grams: tissu(; nonuAl. Heart: Weight, 849 
grams: m<•asnrement^<. 7 by H by 5 (!m.: thickness of wall of right ventricle, 
5 mm.: of left ventriclft, lA cm.: mitral valve insufficient. .Right Inng bonnd 
down to ch«*st wall at lower jiortion: weight. 8:^5 gnuns; measurements, 20 by 19 
by H cm.: color, grayish red: numerous nodules, some hard and some filled witii 
creamy matt-er, found throughout its subst^mce. l>eing es^tec^ially abnndant at the 
n\Hix. ' Left lung bound down posteriorly: weight, 555 grams: measorementi, 
27 by 17 by Gem.: tissue in same (Mmdition as other lung. Spleen: Weight, 85 
grams; miAujurements, 11 by 8 cm.; color on si'(rti(m. reddish brown stxealcMWiUi 



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204 MARINE-HOSPITAL SERVICE. 

ICjO grains. Spleen flmall: interstitial network whit^ and prominent: weight of 
orKan 150 ^rauis. Pancreas normal: weif^ht HO ^ams. Stomach empty; cavity 
enlarged, lining dark and congested. Intestines contained yellow, pea-soup mate- 
rial in small amount; the appendix had a small, firm concretion in the apex. 
Throughout the ilium were beautifully heale<l typhoid jyatches, presenting the 
characteristic shaven-lieard appearance. The recovery waa so nearly perfect that 
the ulcers left scarcely a macroscopic trace of their former existence. 

F. J. T. 

H. W. S. 

Entoric frver. 

L. T.: age, 32 years; nativity, Norwav; adniitt<»d to the United States Marine 
Hospital, StApleton, Staten Island, August 10, 1900; died September 13, 1900. 

Histonj. — Family history negative; past history negative: present history, 
complained for last week of pain in head, dizziness; felt chilly and feverifih at 
times, sweats considerably, feels weak, and can not sleep. Morning teni]:)eratnre, 
39.6 ; pulse, 104; re.spiration. 30. Evening temperature, 41' : pulse, 104; respira- 
tion, 2s ; had tyx)hoid st(M)l. Treatment: Milk diet, turpentine 8tui)e8 to abdomen, 
tub bath if temi>erature ris<*s above 39, aromatic spirits ammonia i5 c. c. every 
three hours. Temjierature evening of August 11, 1900, 37; following morning 
rose to 3.S.0, and that evening went up to 40.0, and for the following day varied 
Ijetween 39 and 41 . \\ith evening rise. 

AnffUHt tJ. — Temiierature normal in morning and for following two niomings. 
with evening rises to 40. 

AiHjKst 14. — Rose-colored si)ot8 on alxlomen. 

August J I. — Temperature has ranged from 39 to 40. l>eing considerably reduced 
after tub baths. Pulse ranged from 100 to 120 and was weak and compressible. 
No diarrh(»a. l)owels kept open with calomel: general condition fair: loedng flesh 
steadily; sordes on teetli and lips. 

August Jl. — Has crepitant rales over right lower lobe and dullness on percus- 
sion. Diplococrcus found in sputum. Cougli and expectoration; 1^. Pill opii et 
l)lumbi, two every four hours. 

.4 ngnst .M, — Bronirhial breathing over l(.)wer IoIk). Discontinue lead and opinm 
l)ills: temi)erature rose to 41 , pulse to 140, r(^si>iration to 40: strychnine sulphate 
0.002 t. i. d. 

August ::, — Temperature ranged from 39 to 41 : jnilse from 120 to 140: respira- 
tion to 40. Strychnine suli)hate, 0.002 t. i. d. 

August 27. — Temptjrature ranged from 39 to 4r; pulse from 120 to 140: respira- 
tion from 30 to 40. Stopi)ed m«*dicinr\ except strychnine: continued baths and nuU: 
diet. Passt»d large ([uantity of clotted blood yesterday: ice applied to abdomen, 
and pill opii et jdunibi, one every f(mr hours, ])res(!ribtid. 

August ,io. — Patient we.ik: temi)erature last three days ranged from 38' to 89"; 
pulse from 108 to 1 lO; respiration from 20 to 28: 7 p. m. had severe chill; tern- 
I)erature,4l.r) ; pulse very rapid; strychnine and whisky administered; patient 
wrapjK'd in sliect wrung out of ice wat4?r. 

August .//.— Pati('nt weak, but bright and feeling l)etter; t'emperatnre in morn- 
ing, 37.2 ; pulse, 12^; respiration. 31: had another crhill toward evening; tempera- 
ture ros».^ to 40.0 : is semicoinat4)se: bhM)d exaiuint?d for plasmodia; none foimd. 
Acid solution quiniiu* 1, hypo<lermically and re^K^ated; strychnine hypodermically 
a<lministere<l. 

Svx)tf'iubi'i' I. — Pat ient rational : teinperatur<* in luorniiig, 41 : pulse, 160: respira- 
tion, 48. 

Srptemhrr .!. — Patient much better; teiniK»ratnr»> ranges from IW toJW"; pnlse 
from 100 to 1 12; 110 delirium: liowels iiiov<* daily. 

Scptrniht r In. — Patient doing fairly well: tenii)erature varies from 38' to 89" : 
lung symptoms all eleared up; inclined to be constiiiated: calomel given to keep 
bowels open: no cliiUs or d«'lirinm. 

Srptrinhrr /.'. — Snlutiou of euthvmol orden^l as mouthwash; tougrne heavily 
coated, whitisli. H. Acid. hydrochloric . dil. gtts. 1."), t. i. d.: milkto l)e predigested. 
1^ Strychnin*' suli>hate. o.oo*i. every two hours, alternating with spirits fmmenti, 
which h«' luis In-eii taking for jiast two weeks. 

Sr/ttriiifur I .\ p. lu. — Temperature rose U\ 4o . Ho complains of congh and pain 
inside: respiration raj >id and harsh; has friction sounds over lower portion of 
left side: i>ulse rapid and feeble: si)onge batli given and stimulations uicreaaed, 
but he griwlually sank, and died at 12.30 p. m. Septemlx'r 13. 1900. 

yrrropst/ itu'vutij-fitur hffurs aftrr dcnth). — li)dy that of a male, apparently 
alx>ut 30 years of age. Considenible emaciation: rigor mortis only dignt. Sng- 



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_ . . S metew; rigor mortis present; sngft'I'itioDS not ^'•'^^^ luurkeil. Brain, UoO 
grains weight. Diim iiutttT wlhercut anil LonBeatwl. Higlit lung, 480 grsnu 
weight: flcmted in ^vatcr. Left limg. 470 grams weight: Souted in water; diglit 
ailhefliou at ajiei. Peril iirdium normal: tissnc of great veaspls infiltrated with 
fat. Heart. 3>'iO gnuus wright. Mnscle of left veutriclu mndi i>u1er than right 
ami InfQtrfttetl with fat. Valves nonnal in aiiptutrann'e and Cduipi'tent by the 
hyilroatatic test. Liver, 1,730 gifTuuit) weight; conge«t«d. Spleen iai rtiuiu 
weight: congested anil friable- Stomacli normal. Large intestine xocciilated. 
riitfif obliterated; walls congeMteil, thin in spute. and adherent, presenting all 

fades of liealwl Hlceis, tSmall intewtine: The ileum shows many healed ulcers. 
i[1iieys.44(lgrauisweight,<'ombinei1; <:ongest<.Hl. Lamyx: The vocal cords show 
fatty changes. There are ulcerating Murfaces in the h»myx which are bathed in 
a thin purulent Snid. Other organs nonnal. 

J. N. F. 
C. W. V. 
J. M. G. 
Biit'Tif fejfr, m'lh rompUtiifioiiK. 

H. P.; age, 24 years; nativitv, Fiiilnu<l: ailmittwl Ui United States Haline Ho»- 
pital, Stapleton. N. Y.. March a. IIWI. 
/rfra///p((fi(i« .—Light hair, gray ej-es, initiiilM II. E. r. and ilate 1877 tattooed 



_n tlie left liHud. 

Ilinltiry. — Difllcnlt to olttain with accuracy, as patient does not s]>eak or under- 
stand English very well and is in a stnidd conilition iih well. Dnrins the part 
nine months he has si>entiitnch tiling in hi isjiitals. at Mobile, Boston, antlNorrolk. 
imffering with riieninatiMui. Huya that bis present illness is of two or three 
weeks' dunitiiin, bnt that he has had a <cmgh (it a hmg time. Has been unable 
to work for five days. Conijihiiiischietlyof Hhortnexa of lin-ath and cough. Only 
venereal triml>le was soft cnancwT seven years (Mfo. 

AViinii'it'iffi'it.— Patient pn^sents the apx^-'^ranee of Ix-ing seriously ill. in weak 
and very short of lireath, au<l is mentally dull. Skin in dry, the cheeks fluahed, 
and the pnlie, althmigh of tair volume and regular, is rapid. Over the entire 
chest there is harsh bnitthing with stinornns and sibilant rides, and moist, bab- 
bling ruUtK. The ajM'x of the lieart is disphu-ed directly' ilowiiward aboutan inch, 
and a loud systolic inunnur is andilile. Tliere is shglit aUlominal tendemew, 
the pplei-n in enlanced to ixTi'nfsiiin. and the Irtnjihatic glands general^ are 
enlarged. Tein|>craturc. at). I. No alHlominal distention or gurgling. 

Coiirni- of itisi'iHi: — Chest syiniJtoma the most iiruniinent; escessive congh with 
the cxi>eirtomtion of bluod-stuineil simtmri. IJon'el^ active, the morementa being 
fluid and yellow. Sjiutum contain-H the diplococcns uf pneumonia in abi ' 
andotbercocd; tubercle bacilli not fotmd. 



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202 MARINE-HOSPITAL SERVICE. 

Treat inrnt. — Stiimilaiit throughout, whisky and strychnine. I(v ami alroliol 
batlis soc'un.Ml slight tcnipnrary reduction nf tempemture. Salol. Prcnli^est*^ 
frxxls. 

\rcn>2).si/ {iinlrr himrs ttfter (h'(tih). — Ki^or mortis and iMVJt-iuortcm liWdity 
present. Eyi's gbize<l and their puidls inoderat^dy and eijually dilate<l. Some 
dried blood on the lips and t<H?th. Brain firm: weighs 1,420 grains. No grow 
changes visible externally. Punctji vasculosa very idainly marked on cut Hurfaoe. 
On incising the a])dominal wall, the sulxrutaneous fat was found to be scanty. 
Skeletal muscles dark cohered. No gross abnormalities of position of viscera 
not^l. Pericardium adherent throughout its serous surfaces, the adhesions being 
apiwirently of old formation. Heart weighs :{80 grams. Both ventricles contain 
(birk fluid blood and jinte-mortem clots, and both are moderately dilated. Mitral 
orifice admits three fingers to the second joint, tricuspid orifice two. The valve 
flai)s of the mitral and aortic valves are thickened, especially the i)08t^rior mitral 
flaj). Myocardium is of about nonnal thi(^kness, of dark red color, and fairly firm. 
Left pleural sac is free from adhesions or unusuiil amount of fluid. Left long 
weighs (MM) grams. Ap(»x of up])er lobe is in a stiite of red hepatizatiou. sinks in 
water, and is friable. The lower jmrt is deeply congested, but floats and crepi- 
tiites. There is an unusual amount of anthracotic deposit throughout the lung. 
Right pleunil sac presents lUJiiiy old adhesions. Right lung weighs 540 grams, 
floats, crt»pitatos. and ])resent^ on cut secticm black pigmentary deposits. 
Mnliastinal glands enlarg«Mi. Great vessels normal. Omentmu contains onlv 
very little fat. Spleen weighs 550 grams, is much enlarged, and ita piUp is darl 
red and friable. Left kidney weighs 225 grams, cai)snle stri]>ped easily, cut sur- 
face pale, but markings are distinct. Right kidney weighs 195 grama, and its cut 
surfaci^ is still paler than that of the left. Intestines generally distended. On 
oi)ening the ileum Peyer's patches were found swollen and injected and a few 
small ones were ulcerated. Stomach api>eare<l normal. Mesenteric glands mnch 
enlarged. Liver weighed 2,150 grams, and was abnormally friable. Bladder 
emi)tv and contnu'ted. Pancreas apparentlv normal. 

G. W. S. 

AV/r (/rowlh, maJigtuiut, (jlavdulnv carcinoma. 

J. F.: age, 52 years: nativity. New York: white: iwlmitted to the United States 
Marine Hospital, St. Louis. Mo., November 29, 1900, and died December 2rt, 1900. 

Histttrij. — Patient stated that lie had had dysi)ei>sia for two years, and that he 
had been feeling especially Imd for the past six days. He complained of nausea 
and pain in his stomach. He had eaten very little for two days, as he became sick 
s<x)n after taking food in his st^jmach and usually vomited it. He said he had a 
chancre twenty years ago, whi(*h was follow^ed bv an enlargement of the glands 
in the groin, sore throat, and an eruption on his IwHly. 

Pht/sical c.vmnhtatiftn. — Cervical glands enlarged; slight dullness on percnssion 
over both lungs: the respirat^)ry sounds are roughened, but no rales are present 
A blowing murmur is heard over tlu; ajx^x of the heart. A tumor is felt extend- 
ing from 1 inch below the xijihoid cartilage to th(» umbilicus. This tnmor is hard 
and irr«*gular in outline, and the pulsations of the aortal are transmitted through 
it. Th«' spleen is slightly enlarged. The vomite<l matter is of a yellowish-green 
cijor, and has an acid rejwtion; no free or combined hydrochloric acid is present; 
no crlls res<'inbling cancer cells can bo found by the microscope. On Novemh^ 
Hi. at 2.:{o a. m.. the j^atient vomited coffee-colored matter after an attack of severe 
])ain. Tlie (•asi> was thought to 1h^ one of cancer of the i)yloms or dnodennm,and 
an o])erHtion wasadvis<>d. Imt thn patient would not (consent. Ho continued to 
grow worst' every day, living chiefly on buttermilk, malteil milk, beer, etc., and 
when tliese wi.Te not retained l)y th(j stomach he was fed by recital enemata. He 
became gnatly emaciated, and died of exhaustion at 4 p. m. December 26, 1900. 

Xrrrftpsff {Imiitif himrs it/frr r/n ////).— Height 1 70 cm. , alxlomen \xMt shaped. 
alnlominal walls 0.5 cm. thick: the nniscular tis.sue is of a bright reil color, stomach 
greatly dilated: gall bladder full: a large, hard swelling is present in the epigas- 
tric region. Brain: Weight, l.:i.">o grams; tissu«) normal. Heart: Weight, 249 
grams: measurements, 7 l)y s by 5 cm.: thickness of wall of right ventricle, 
5 mm.: *»f left ventricle, ll cm.: mitral valve insufficient. Right Inng bound 
down to chest wall at lower jiortion: weight, HrC) grams: measurements, 29 by 19 
by H cm.; col(»r, grayish red: numerous nodules, some hard and some filled with 
creamy matter, found throughout its sul)stanc4'. l)eing esjiecially abundant at the 
apex. Left lung bound down i)osteriorly: weight, 555 grams: meaauromenta, 
27 by 17 by Gem.; tissue in same condition as other lung. Spleen: Weifl^t, 65 
grunis: meusurement:^. 11 by "^ cm.; color on section, reddish bxown streakwwith 



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I 



204 MARINE-HOSPITAL SERVICE. 

IfiO ^'raius. Spleen Rmall: interstitial network whit^ and prominent: weight of 
orj^aii !.")() grams. Pancreas normal: weight HO jn'ams. Stomaeh empty: cavity 
enlarged , lining dark and congestinl. Tnt^estines cont^iined yellow, iiea-sonp mate- 
rial in small amonnt: the apj)endix had a small, firm concretion in the apex. 
Throughout the ilium were beautifully healed tjTihoid patches, presenting the 
characteristic shaven-beard api)earance. The recovery was so nearly perfect that 
the ulcers left scarcely a macroscopic trace of their former existence. 

F. J. T. 

H. W. S. 

Enteric fever, 

L. T.: age, 32 years: nativity, Norwav; admitted to the United States Marine 
Hospital, Stapleton, Staten Island, August 10, HMM): died Septeml^er 13. 1900. 

Ilisfitrif. — Family history negative; past history negative: present hist^^ry, 
complained for last week of pain in head, dizziness: felt chilly and feverish at 
times, sweats considerably, feels weak, and can not sleep. Morning temperature, 
39.6 : imlse. 104; resjaration, 30. Evening temperature, 41 ; pulse, 104; respira- 
tion, 2S: liad t>i)hoid st<x)l. Treatment: Milk diet, turpentine stupes to abdomen, 
tub bath if temperature rises alK>vo 39, aromatic spirits ammonia 15 c. c. every 
three hours. Temi)erature evening of August 11, 1900, 37; following morning 
rose to 3H.(), and that evening went up to 40.G, and for the following day varied 
l)etween 39 and 41 , with evening rise. 

August ]L\ — Temperature normal in morning and for following two mornings, 
with evening rises to 40. 

August l!f. — Rose-colored 6p)ts on abdomen. 

August ^*1. — Temperature has ranged from 39 to 40, being considerably reduced 
after tub baths. Puh<e ranged from 100 to 120 and was weak and compressible. 
No diarrhea, lx)wels kept open with calomel: general condition fair; losing flesh 
steadily: sordes on teeth and lips. 

August ;//. — Has (Tepitant rales over right lower lobe and dullness on percus- 
sion. Diplococcus found in sputmn. Cough and expectoration; 1^. Pill opii et 
plumbi, two every four hours. 

August ^'.>. — Bronchial breathing over lower loin;. Discontinue lead and opium 
pills: temperature rose to 41 , jmlse to T40. respiration to 40: strychnine sulphate 
0.002 t. i. d. 

August .J7, — Temperature ranged from 39 to 41 : i)ulsefroml20to 140; respira- 
tion to 40. Strychnine sulphate, 0.002 t. i. d. 

August J7, — TemiKjrature ranged from 39 to 41 '; pulse from 120 to 140: respira- 
tion from 30 to 40. Stopi>ed mediciiu ? , except strychnine : continued Itoths and milk 
diet. Pa.ssed large (juantity of clotted blood yesterday: ice applied to abdomen, 
and pill opii et plumbi, one every four hours, ]>rescribt*d. 

August ,10. — Patient weak: temiK'rature last three days ranged from 88* to 39°; 
jmlso from lOs to 1 10; resi)iration from 20 to 28: 7 p. m. had severe chill; tem- 
l)erature,4l.r) : ])ulse very ra])i<l: strychnine and whisky a<lministered; palient 
wnij^iKMl in sl^eet wrung out of ic(> water. 

August ,il. — Pati«'nt weak, but bright and feeling lietter: temi)eratare in morn- 
ing, 37.2 ; pulse, 12H; respiration. 31: had another chill toward evening; tempera- 
ture rose to 40.0 : is semicomato.se; bhMKl examined for Plasmodia: none found. 
Acid solution quinine 1, hyi>odemiicallyand rei)eat<»d: strychnine hyi>odermicany 
administerwl. 

Septeniher 1. — Pat lent rational: tenipt*raturein morning, 41; pulse, IftO; respira- 
tion, 4H. 

Septeuilh-r ^!. — Patient ninch better; temiKM*atnr<' ranges from liH " to 39": jralse 
from 100 to 112: no delirium: l)owels move daily. 

Septruitter /^y.— Patient doing fairly well: trnijwrat.u re varies from Ji8** to 39'; 
lung Hynii)toms all cloarrd up: inrlintMl to b(» (•onsti])at<'d: ailomel given to keep 
l)owels o]M'n: no chills or dt'lirium. 

Sepft iiihrr I .'. — S<>lnt.ion of cut hymol ordered as mouthwash; tongue heavHy 
coated, whiti.sli. H. Acid, hydrochloric dil. gtts. J."), t. i. d. : milk to 1)e predigested. 
I^ StrychniiK^ sulphate, o.oo'j. every two hours, alternating with spirits fmmenti, 
which li»^ has Imm'u taking for jjast two w«'cks. 

SipteuifK-r I !, p. III. — TeniixTature rose to 4() . He complains of congh and pain 
inside: resinration rai>id and harsh: has friction soimds over lower portion of 
left side: jiulse rapi<l and feeble: sponge l)ath given and stimulations Ukcreased. 
but he gradually sank, and died at 12.30 \}. m. Septemlxn* 13, 1900. 

ytrrapsif (ttrentif-fnur hours after (Jntth). — liody that of a male, apparently 
alK)ut30 years of age. C'onsidenibh' enuu'iation: rigor mortis only slignt. Bug- 



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I. 1 



206 MARINE-HOSPITAL SERVICE. 

M. H.: whit<>: nativity, Illinois: a^e, 22 yoars: admitt^Hl to United States 
Marine? Hospital, Detroit. Aufcnst 1. IIMK); ditMl Seittember 3, IWX). 

llistnnf. — Patirut stated that \\i\ luwl l)pen sick for two weeks before hii? admb*- 
Hion to the hospital and ^ave a history of heathu'he, dizziness, anorexia, and 
diarrhea. Ilin tongue was thii;kly coated, l)road. and flabby; spleen enlarged 
and tender; gurgling and tendcjniess in right iliac region; aMouien distended 
and tympanitic. The diagnosis of enteric fever was made, and sub8e<iiiently 
confirmetl by symj^toms. and the •' Widal reaction.'* 

The case progressed favorably until August 19, when sjTnptoms i>f congestion 
of right lung apiHMired. On August 24 copious hemorrhages from the bowel 
occurretl, the patient voiding clots for two days, and IxH^oming very weak and 
emaciated. From this he failed rapidly, \v\\i\\ i>ersistent high temi)eratTire until 
SeptemlMjr :t, when he died. 

Necropsy {eleven hours after death). — Body of medium-sized man, inach emaci- 
atetl, with no special marks. Rigor niorti.s pronounced. Calvariiini removed: 
dura aniemic; brain slightly congested, but presented no discernible lesions: 
weight, 1.020 grams. Chest and abdomen oiK^ned. The right lung was slightly 
adherent to parietes, very mucli (rongesttHl. and contained a nnml)er of caseons 
tubercles in upi)er lobe: weight, 950 grains. The left Inng was jp"eatly con- 
gested; weight, 720 grams. The heart contained ante-mortem clots in both' sides, 
otherwise appeared normal; weight. lUM) grams. The liver was pale, but other- 
wise normal in apix'arancre; w^eight, 1,990 grams. Spleen normal; weight. 340 
grams. Both kidneys normal; weight of right, 220 grams; left, 240 grams. 
Stomach greatly distended with flatus and curdled milk. Intestines: The jeju- 
num and ileum showtnl much glandular inflammation with nnmerons olcera- 
tioiis. The coh »n was constricted about 20 cm. alx)ve the sigmoid flexure, probably 
the result of an old dysentery. There was a genenil involvement of the intestinal 
and omental glands, many of them being in an advanced state of nlceration. 
The other organs were normal. 

£• K. S. 
J. G. 

F. von T.; white: age. 22: nativity, Holland: admitt^Ml to the United States 
Marine Hospital, Baltimore. Md., June 21. 19(M); died July 24, 1900. Diagnosis, 
enteric ftjver. 

Fam ill/ h istori/. — Go* m1. 

Previous hiatory. — Habits good; nev(T had any venereal disease; had malarial 
fever two years ago. Present illness began with a chill on Jane 18, previous to 
which he fiad not felt well for Ave or six days. Following the chill he had fever, 
but no sweat; felt quite sick up to the 20th of June, w^hen he had another seven 
chill, after which he felt very weak and dizzy. Was admitted the following day, 
June 21. CJn admi.ssion the jiatient's general ccmdition was good; bow^ consti- 
pat^'d; abdomen distendeil with gas; comjilained of headache; temperature, 89.6 . 
The next morning the tem])erature was 87.8 , and ran an irreralar course throngh- 
out the rest of the illness. Eruption abstait: alxlominal tenderness not mazkea at 
any time during the course of illness: characteristic tvphoid stools. Jnly 18 
patient complained of slight i)aiii in l)oth knee joints, wnich, however, soon dis- 
api>eared. July 22, at 9 a. m. , both arms were noticed to be swollen in the region 
of th(; elbow joints and aT^sociated with constant and severe pain and tendemesB, 
b«»ing more ])ronounced in the right arm. The swelling increased very rapidly 
tlin )ughout the day and su(;ceeding night, and on the following morning it extended 
from the shoulder to the hand and was (edematous in character. The next day. 
July 2-1, tlie right arm was swollen to aVM)ut three times its normal size: left arm 
was also greatly enlarged. At 12 o'clock of same day pronouncetl gaseous disten- 
sion of tilt' alxlonieii develo])ed. followed h\ rapid and feeble heart action and 
shallow and hnmeil respiration. Patient died at IJ.-Ki p. m., July 24, 1900. 

AVc/v>y>.s7/ (riffhtren ht)ursaj'ter death). — Post-im)rtem li\idity marked independ- 
ent parts: rij^or mortis disappeanng: l>i>dy emaciated; pupils equal and dilated. 
Pericardial siw opi'ued: contained 110 c. c. of straw-<;olonHl fluia. Lnngs: Bight 
weighed 7h\T} grnnis, left one 4:50 gi-aius. Both lungs showed hypostatic cxmges- 
tion. Base of left lung adherent to chest wall posteriorly and to the diaphragm. 
A})domen <list<'nded with gas; stomach emi)ty, niniuc'il in appearance; lower jAit 
of small intestine highly inflani(Ml. ])resenting numerous i)oints of ulcerataons. 
one of which ]M'rf orated all tin* i-oats of the intestine alxmt 15 cm. from the ileo- 
cji*<al valve. No fecal matter had esca]MMl into the alMloiniual cavity, nor was 
there any eviden<'(* of hemorrhage. Mesenteric^ glands were enlarged. Vermi- 
form ajipt^ndix nonnal. Large iiit<'stiin» emi)ty and in nowise involved. Liver. 
Chocolate color, somewliat engorged; in other resi>ccts normal; weighed 1,97$ 



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208 MARINK-HOSPITAL SERVICE. 

November 2S. A small aliscosfl was fonnd, lightly confincHl by peritoneal adhe- 
sions. The appendix was curled on itself like a snail shell and Innuid together by 
strong fwlhesions. and was iH»rforated near the tip. A 8i)ot on the Cjecnin within 
tlie abscess area lookc^d very dark and almost ready to form a Hlongh. The 
appendix was removed and tho wound was drained with iodoform ^aiize. After 
operation the patient was ncTvons and restless and inclined to vomiting, but jno- 
grossed fairly well for the first three days. 

JJecewhrr /. — The Innvels moved well for tho first time, and with the aid of an 
enema api)eared to l)e thoroughly unloaded. The morning of December 2 the 
dressings were changed and the strands of gauze drainage renewed, all except 
one. There was only a slight purulent discharge in the dressings and the patient's 
(Condition was satisfactory at this time. In the evening of the same day he wm 
taken suddenly with iK*rsistent vomiting, which soon became fecal in chiuracter, 
and th(j abdomen again l>ecame <listende<l and tender. A high eneuia was given, 
the dressings were changed again and mor])hine administered, and the patient 
IxHramo easy until (^arly the following morning, when the vomiting w^aa renewed 
and his condition rajndly })ecam(j hoi)eles8. He died at fi.50 o'clock in the evening. 

Nrrnppsf/ (eHjhtrm hnitvH after drtith). — Body well nourished and mnscnlar. 
Scars, apparently the result of a wet cupping, on tho chest below the right clavi- 
cle. Rigor mortis. Slight post-mortem lividity. Operation wound abont 8 cm. 
long in alxlominal wall at outer border of right recttus muscle in iliac region, 
pirtly clostnl with sutures. No pus fiowed from wound, but a small amoant was 
in the dressings. Bonos of skull very thin. Small amount of semm in the men- 
inges of the brain. Sinuses and bloo<l vessels mcxlerately full of blood. The 
brain weighed 1 ,57.") grams; externally and on section it presented no nnnsnal 
«])l»earance8. There wiis a moderate amount of clejir serum in tho pericardial sac. 
The membrane was smooth and bright. The ai>ex of the heart extended slightly 
to the left of the nipph? in the fifth inttjrsiwvce. The left ventricle \vaa contracted 
and empty, the right relaxed and full of dark-liquid bl(M)d. Small buff clots 
were in tin* aorta and pulmonary artery and adherent to the waUa of the ventri- 
cles. Tho aortic valve withstood the hydrostatic! test; the pulmonary artery was 
very relaxed and the valve would not close to the tost. The valve segmentn in 
lK)th apiM'art^l sound. Tlio mitral orifice l>arely admitted the tips of two fingers. 
The tri(uis])id orifice admitted fc^ur fingers. The wall of the right ventricle was 
estimated (5 mm. thic^k and the left 20 mm. Tlie heart weighed 385 grams. The 
left lung was nonadherent: it only collapsed slightlv on o])ening the chest, and it 
pitted on jiressuro externally. The tissue crepitateil and fioate<l in water, and no 
consolidati.Hl tissue was found: the lung weightKl 545 grams. The right lung was 
nonadherent imd scarcely collapsed at all on opening the chest: it pitted on pres- 
sure externally; the tissue crepitated and floated in water; it was filled with 
dark bhnjd, but fre<» from any consolidation: the lung weighe<l 075 erams. The 
alnlomen bulgi'd and the intestines were enormously distended with gas. The 
om(>ntuni overlay the intestines and was lightly adherent to them, and a small 
amount of filiriuous exudate bound the coils of intestines lightly toother imme- 
diately bt>neath the omentum and dt;oi)er in the right lumbar and iliac regiooa. 
Even at the site of tho operation on the ai)i>endix the adhesions were not fixm. 
Tliere was no pus in the peritoneal sac. and, except for the slight fibrinous adhe- 
sions at the i>Iaces nauKMl. tho mem})rane was smooth and bright, though the intes- 
tinal walls were discolored and livid. There was a small amount of clear semm 
in the deiM^ndent parts of the ca\ity. The colon had no mesentery in the ascend- 
ing or descendin;^ l)ortions. The last jiortion of the ilium, to a point near the 
ciecuni, had slipped fur down into the i)olvis, turning upon itself and f Qrmixig a 
volvulus whieh constricted the gut lM4we<'n tho mesentery and the brim ofwe 
]M'lvis at a distance of about H cm. irmii the; cipcum and caused acute obstruction. 
Tlio gut was held in tliis i)osition by tho fibrinous adhesions. At the point of 
constriction the wall of tlie gut was very dark colored in its entire thickness. The 
gut beyond the (constriction was largely collax»sed; abin^e the constriction it was 
distended. The; stump of tho apiK*ndix was in j)rocess of healing, as was also the 
lM»rtion of the wound in the alHlominal wall which had l)een sutured. The spleen 
was very small and weighed IKS grams. The left kidney weighed 230 grams; the 
right *2'i') grams. The (rapsules stripped readily. Tlie tissue was mottled, the 
left being darker than the right, and the natural markings were distinct. The 
liver weiglied '2,ojj grams, and had nothing unusual in its appearance. The btad- 
der contiiint<l a very small (luantity of urine. 

G.W.& 



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II 



210 MABINE-HOSPITAL SEBVICE. 

APPENDKITIS (FULMINATING VARIETY) WITH EXTENSIVE SUB- 
PERITONEAL SUPPURATION. 

H. F.: age, 21; was admitted into the marine ward of St. Mary's Infirmary 
June 4. 1 9<)1, complaining of symptoms pointing to appendicitis. 

He gave a history of no previous illness of any moment, but BtAted that on 
June 1, 1901 , while at sea he was seized with a severe pain of a colicky character, 
at first fairly generally distributed over the lower abdomen, but after twenty-four 
hours becoming localized at the umbilicus. He had had diarrhea and occasioiial 
vomiting. On admission at 1 1 a. m. the ]>ain and tenderness were fairly definitely 
localized over the api)endix, when* also there was a very definite sense of resist' 
ance. His tem])erature was 101' F. There was also a distinct hardening and 
tenderness in the middle line from the pulx^s to the umbilicus. Ox)eration at 4 
p. m. on day of admission. The appendix was readily reached, l)eing situated ia 
front of the colon, and it, with the cai)ut ca>cum coli, was entirely extraperi- 
toneal. It api)eared gangrenous at the middle and was surrounded by a curious 
black gelatinous materiiU which I have never l^efore seen in any laparotomy. 
The api)eiidix was removed and the wound drained. His temperalmre fell after 
the operation, but though there was no discharge^ in twenty-four hours fromtibe 
operation his pulse got progressively weaker. In thirty-six hours after the oper 
ation there was a i)rofuse discharge. An attempt was made to establish tnt 
drainage, but it was felt that there was no hope, as the patient's pnlsi^ had becosie 
very weak. He died at 10 a. m. on the second day after the operation. 

yvcropsj/ {two hours after dfitth), — Body of a well-nourished, mnscular, young 
man; i>ost-mortem lividity well marked: rigidity not yet apparent: body warm: 
height , 5 feet 8 V inches. A small boil is noted over front of left knee. Pupils mod- 
erately dilated. e(iual. Fac^e exceedingly livid. Surgical wound, 3inche8 inlen^h, 
over apiHjndical region, shows the tissue in a blue, almost gangrenous, condition. 
Crepitation of the aMominal wall on the right just beneath the margin of the 
rilw outside the rectus muscle. Abdominal wall: Fat of the al>doniinal wall has 
a gn^nish apiK^arance. Below the umbilicus, on ox)ening the sheath of the rectos 
muscle, the whole sheath is greenish and infiltrated. The posterior surface of the 
n>ctns is covered with greeni«h lymph. On optMiing the space of Retzius a large 
quantity of jms escaped, from which cultures are made. It is noted at the time 
of ox)eratiou that a sense of resistance was given in this region, though no pain 
was com^)lained of. The whole abdominal wall in the subperitoneal tissae baow 
the umbilicus seems one continuous sujyu rating cavity. Omentum, etc.: On 
oiwning the pt'ritoueum the omentum is found adherent to the IntesdQes. TTie 
subperitoneal supi)urating ])rf Kress has spreatl half way up between the nmbiliciu 
and th(^ x3'i)]ioid cartilage, and in sevenil places it apx)ear8 as though the sappa- 
ration had x)enetrated from outside: but this is doubtful, as there is a snppnratiTe 
process behind the omentum in these sites. The omentum is deeply congested, 
esiHX'ially down in the pelvis. It is adherent to the small intestines all over, and 
occasionally the adliesions are of a yellow character. Along the line of the tranf- 
ver8<» colon and Iwtween the layers of the omentum are similar yellow depoaitL 
The liver is adherent to the omentum, hei)atic flexure of the colon, gall bladder, 
and pyloric end of i\m stomacrh, as well as to the lesser omentum, by a similar 
exudation ( »f a yt'Uowish character. Old adhesions, thoroughly va8ciilarij9ed,esilt 
l)etween the underside of the gall bladder and omentum. The peritoneonEi on 
the posterior wall of the aMomen is extensively infiltrated with small sappantiTe 
areas . The small intestines , especially where in contact with the i)el vie pentonenm 
or omentum, show areas of deei) congestion. The ileum, at distances of approxi- 
mately and \x inches from the ileocjecal junction, and the sigmoid flexnre are 
lw)und down V»y ])ale yellow recent adhesions. Tlie api)endix, which was fomid in 
oi)eration to lie in front of tlie ciecuui, has been entirelv removed (was completely 
extraiK'ritoneal ) . Its bas(» is gangrenous. Pus ext^'uds behind the cecom in the 
jwritoneal t issue up as high as the liver and on to tlie under surface of the diaphragm. 
It i)ass<>s d«>wn into the i>elvis and runs al<nig the ureter, crosses over in front of 
the aorta, and H])reads along the left ureter and inferior mesenteric vessels. It 
apjK'ars \o have spread u]) along the mesentery of the rectum and other stmctnres, 
passing down into the subperitoneal tissues. * Right lung: Old pleuritic adhesions 
over tin.' ajw'x. hyjHistatic congestion of lower h)l>e. otherwise same as left organ. 
Sph^n det>ply ci )ng<*sted, hemorrhagic in small iK)ints: considerable hemic pigment 
in granules s<'attered about. Psoas mus<'le also contains pus. although toe right 
muscle se«*ms to have escaptnl. The pyogenic pr<K*es8 is more advanced in p^ls 
lN*hind tlKMN'ctnni and around the bladder than anywhere else, the whole tiflBoe in 
front of the bladder Idling full of tliicrk yellow jms. Stomach and small Inteatinea 
api)ear healthy .except for l(?sions alM)ve mentioned. Large intestine: GapatcBcnn 
coli is somewhat injec^ted, but otherwise a])i>ears normal, except as above fltafted. 




MARIiCK-lKisriTAL sKKVirK. 211 

';«s.r7 4; 'f ihi- a|if»fiahx u ■litfhtU n^Mi*ii«il mv\ i IimiI )iy thi'ratirnt hiritnn* 
Mftm 9z' t*^ tn'vins In lb** oiliiti. •-ft|«<i-ially at th«* '>]ili-iiii- fl«'3iiin«. th*- -xililary 
tfilbfta*^* AT^ «rr« |>n<ntiii-fit. and iIh* (■•Wfl hun a hrn^ tn*>h \*»tk. Hi-M 'if larp' 
i:s^ •h»'«B tit»ihinjc •liivimia). S|ilt^'ii in i-tilar^'t^l. t^tU, tl«f|ilv <'i>iik'»*M«^]: 
«c--ASi Ualir* pnituini-nt. Livrr. liall MaiMcr i"* iSi*<t«-n«li^l witli liilt*. Tlif 
aa t**-^ i«-lkiW in CI ill. r an*! ilt^fply i-i>ntf('fit«'il: hiIhtwi-^- imniial. Tlif tiilt* \n 
mtT^lj thsrk fn<n tnni-nii an«l almnilaiit. I«*-ft kuliifv: A ikirk <M.irk i ^'flat- 
» KAirruii »QrT«>nb<lik \hm ki«lii«'\ . tin- lirhruii i** <li*«*|iiy • ••iii:«-M«'<l. ••thrrwiiM> 
» A'TVi*] Riicbt kitlnf% Siirri'iiiitlf<il )«y fairlv in-althy ti.<^ii**; ntlxTwiM- 
t«> Wfl fTtfan. aiiuill lSini'ri-ahai>|«ap» nnniml. <'h••^t; Th** |**riran]iutii 
• tiunl lli-an Tlif ritfbl aiihrli- i-* full of ilark M<"mI «'l<<t. Tli«* vi-ii- 
>l >ft a^intif ar«- rinitt) Acriir niiil |-iiliiiiiiiary vahi""! an- riiiii|M-t«'iit 
«r II' art a| ]--«r« ti- niial. I«t ft luiiu'- l^'Wt-r 1**U' il«<f]ily i*tinh;t-»t*tl 
ky^«8at» "tl.«*niiw n'-mial I«i\fr •!•<• ply rtiiit;*-«tt-«l. i •11^ i-liiu>l\ . ^Wflliiii;. 
bS 2:St> jixibrtxl i'**!fn •li#;ht th:t ki tiirik' « ( inuri*^ifii>inr<'iiiiilHvIliiitiltnitiiiii: 
f sa*^ » vtri»r.! ' f |»-nt«'fifal la>»T"f »M, ti II Ltiii;:*!!*'^ j«ly i "ii»;f*ttil with ititt-r- 
Tfyfc' ij«^^ rTi.A«;« . >• uif h« iii«irrhak'<* ii>''* air ••{••mi-*, h.rinn- ahil ixtmial pi;;- 
weSAS> c. Il«art li'i nuirkitlly iii\>>I\i-<l. .1 fi-w til^i r?* >\vi>Iliii aii'l k'niiiuliir: 
^•2^*m'' >•<:••»«•!:• ii A* ria i;«>t a)li-n-«l. 

• -^^^^r*^ v.^lr fn»tn lln- n-*ri"ti ••' tin- apiK-tHhv. th*- |iii»« 111 !)!•■ f^i^a* •■ i-f Ki*t/.im<. 
aflii tr-' ^'.^k;^ n'* laliiKiiin tinf^iii' ariiUXiif th«' l*-ft kuliifv -Ifiuiil aliiimt \n\r*' 
MT 'w*^* - ' a l» Kln« whii h ili***! ti<it • ••rr* ^i-'Tk! with r)i«> Uii illn** cf aii\ h'Iiit 
tl> . r:^- unttT i-r il.»' iiatli<l<>k'i-t« in tl.f Mat*- iiii:\i r-ity .ir-- faiuiliar. 
• «r )«-intf iiia<l<- with .1 \ii-w •.. ih* .r i.iri-fiil il* •*'-Miitii-ii ami 

W. K. 
I'i:km»NITIS Ki»LlJ»\VIN«. LAI*AKi»T«iMV 

L {• ^^ '•. >»--»r« ii.iTiVi'\. >\vi •It'll w.i- .fliniTfiil !•■ 'i;.- riiiT«-il Stat**^ 
Mrar I! •S'-^: I '!.«-:•• it M.k— . M.iv JJ ai.'l "IJ"! M.i\ .'." :>•■ 
." r^ -# V '.;x^!. •;• ''f r»'tr'» j*Ti!«»i.»-.ii ^r -w*, j.r kiril-, .I'l- !i->iii.i. luiMiii; 
W» i A."" *••! -T A jkift«r Ti.|j»y wa« j-rf'-nipil .ir.l ^^V" larj- lt-'Wi.-* • !i'.;. ). a!*-*! 
?r ■& t.'.>» .« l*« •i^« tiki aiiil |«»«t iti.i< r*'ftn-'ii. Th' r*- w.t- • • •'.-:•!• r.i''!<- h- iU'>rrh.ij*- 
:. ■ »• ar?^M««l li% tfaiut- ii.ii kiiit:. at)<l i."ni.al -.tit «"I-:*:><ii \\ .»<• iiii<->:»il. 
^ct rvAft'*! ^'Ty «• II. altlMtu'h tii«-ri- w.i- ■ <<ri»ii!i r.iM** oh-- k .11. -l .1 t< iii|"T- 
^ % «' A k'**>l •li-.il I'f liATiva wa- ••\i"-r;rii« ••! ! r wh:< !i ini'k<-l i> • au*\ 
■* * ■!.&' .T : w *>• • r'l»T««l 
M.f ' ; ' ^^"* tiiiii- |kiTi*n! h-»'l fu 111- '.I'l-f.M •-■r> ;r ■.•r« -- «!.-:» ):•• 

BML * t-.^'T fr 111 t*aii.« a ati<l v-iiiitiiik'. II*- • 'i.-l r< '.i.!. >• i:.- im.Ik t* ".im- 
p ,vkj:.7.^* f u.:lk m a* •uiall a*.<! <-ii*- thir>l liiii- x^.t'^r 

Ti»"*« *» r.»' • 1 ;l»-r- •• • f ••>■!• inn. al ih»!«ii':'f; a f'-'al •■:^« ■.*.»- :!.' r--l'ii • -1 a-* 
a* ;•«».'«•' f r ••.! w hi> h |«ii— «-<l 1 i'ti-hl* i.ih!* »m- A:. • *.• t:..i w .i> ,:'.\'riiit 
■ci«- T.iLi* >'.l HA-ij-'t f'-fiirn'*! T- .i-i--'lif'.i -l- .. - . ■ ii..i»'!.' '.■;i:i >til{.h.i!>- 

Li«^& — V^^r^l • \rt\ hmir ?««r thTi-t- h ur- 

Jl«9 I'a'^t4* 111 \*T\ Ji'"*-r • xri'Lv •!! i'..iri<:.i.'< **.ii^' \'r> *i,:h?. 1? ^%;i« 

•1 ! r*Tjr w .ir*-'*w:ii»: W><mi>1 \%.i« in .tii * \> • !!• '.t ■ --i: l:*. -i. Al-l- i.-i* ?: ■!'.- 
S • !:. ^AB ?''ii ii"t t»-iii|iT ••II I'f* — III •■ h-r il: ! !! • j- 1* ■• • ' ■ • t:i;i'.i.!. ■ ? ; i.ti 
cJti •-•i^t»«> iif |wni*iiiiti* u.i« th<- •li«ti-ii!.<-ii .ii.-l !•.• ».'• i.f! ii!'* ■ •-!!.i;"« •' 
m^ w ' A Xhr \mtU'Ul Vi'iiiitii.t; • -iiT:ii>ii^l .1' -.iit«r\.i!- 

}«f f irv/« V ^f*«(f « ilf f< r ffa •tf/. 1 \t^ .1:. 1 I ? • • h- - .l.k< I. • ■ • I. . I '1 ■ 

ar nsa! « "U^.'l |a-ti;*. aii«l ^ r<>!i.li. > \.i!. •!: • • L'l- I. ' ' ■.. • ; .1 ■ .' : 

^r^^ ««r« ii^/kr«! TIf- lli> Uiixii > •(*•!.!'••: .1 > .r . . •:. * : .t.' 

'I.J -«• »• tTMi-.i.M' at a !• lilt 1 : . ii .!'• \t •? • !• ■ ■ ! ■ ' " ■ .: ' . i? I 

■ ^^!:?« *. « t.«ar«l !•• a |«iiiit .' I III .■'> ^* 1' ;:m:' < i.. i!..* ' * I.'. 4. :- 

»*• ^f 'j ■ t . : 4*^ 111 tl.»- !• wt r I .■rii« r . f » ■u!.-! •!. :■ \* .1- ••. i' - ■ • • ^ •:..• 

fr • a*^ ... f } ti» rilt-fuliii,; il-.w !i it.tx M.' -. r * .1!. 'i'*:: .. * V. :; 

• r-t W ■«■ -^Vti aff*.! vhtiW* •lirfi« xf •• • l.\lii'-> !'• : .rl ii. :-• rii.i; •:. 1 
1*A* •'■«st *«< • r. iif t'lrllil fluhl Ml .irt v« • l^!. >■• . - i i ■ ' • !..•:%%'-. 
•cj^^ <ViB ' S«4«. «alir« fii*riiial ICi-'h! !m? p.* a« • .. ^- ' . ' *• - .i* 1 ■ !. ■• - - 

k4 k«s#a»tAtli «>1l|S*«ttiin l^fl lutikT V^*-:i.'h- •r<.r.il.'. .1 -.%--_■:.- 

■Mf r^^k^T'miym anal was ailhi rrht on l^« -I..!; f.: i.i . 1' .rr 1 * • v ; 

• « •^mU.tU^ WiiQbrI tlir Ifitr^tlTM « Wt-rt* f><<ir.| .h-\*.- * • - I-.' I:. 
r^rmli y *imtrta$lrm\ W\lh timm i Mii* Ijt ulii !■< .fill* t > - ' ' \ *•■•.%'. .\ t '. !'• 

; V»y«-r '-f thr »tiadl iiilr«tin*-ii in th* i- .-■ 1. •■' " v« '. ! ■■ ir.r! h 

^ a»llkrviiai« afr fifffiii'^l l**-riti'ii' iiii . p'!.ii.-<l ?i.> ^% 

m 11^ Ufl ihac t^ififm AUbituiiiJil • ii%i'\ i- ii;:^-l ^^ -'h •>.>-:■•: • i ! '- ? 
tri i* g^ « 4r a fi Mi r al |» ninniTi i liall tiLuM r • >.■ i.ti- i- ' ' • i. i 

mm^mtml LItaf wvt^lla I.^mi irrain* an^l "Iti^hf 1\ • ••ii.;' ^'^l •M.tivt:. 1. 'i..!! 
I^fi kitery wiigki 9U graiua aiiil «.i- tiUfl^.th v |..M...k> K .:!.'. 




212 MARINE-HOSPITAL SERVICE. 

kidney weighs '2i\0 gi'HinH »n<l was normal. Spleen weighs 26() grams: was bound 
down l)y iMlliesioiis: capsule wtis adherent. Bladder was friable and contained 
al>oiit 50 c. c. of turbid fluid, containing cheesy masses similar to those found in 
the left kidnov. Brain weighs 1 ,490 grams and is normal. 

F.L 

Wound t>f jntrictes of alxhrmni^ itcnetrathuj^ incised, pcriiointiH, 

W. T. (colored); age, 81; nativity, Virginia: admitted to the United Stotw 
Marine Hospital, Evansville, Ind., February y, VM)\\ died February 7, 1901. 

, ( 'Jin ical h iaUtrij. — On admission (7.15 p. m. ) he stated that at 11 o'cloi'ik a. m. on 
the day before he ha<l received a stab wound of the abdomen while on the boat np 
Green' River near Bowling Green, Ky. He received medical attention at onct*. 
Patient was aiuesthetized; wound investigated; no injury to intestines fonnd: 
wound sutured and dressing aiiplied. (.)n examining the patient a wonnd about 
1 cm. long was foimd just to the left and a little above the navel. Patient seemed 
to Ix^ in gocxl condition; no f(?ver; not much pain, and that just aronnd woond. 
He could handle himself i)retty well. Pulse was good, and patient's heart and 
lungs were normal. Wound was dressed. The next day ho felt better. Pain and 
t<^ndemess was less. That night he vomit^Ml a little, and at 9.30 p. m. he hadi 
free voliuitary action of the lx)wels. This made him feel much better. He took 
milk, l)eef tea. and a little whisky during the 5th. 

Next morning he took a turn for the worse: abdomen enlarged and 1)ecanie 
tense, and jiain increased. He vomited considerable. Two enemata produced 
free action of l)oweLs, which relieved him for only a short time. Ammgements 
were made for a laparotomy, which was l>egun at 6 p. m. on Febmary 6. An 
incision about 13 cm. long was nuMle. with its center at the site of theorigiul 
stab wound. Some dark-colore<l blootl was found in the abdomhial cavity. The 
intestines just under the wound were l)ound together by adhesions. A small 
XKM'ket of til in pus was found about 5 cm. down. This and the blood were care- 
fully inop])<'d out, and then the cavity was flushed with a decinormal salt soliition 
at 37 ('. No point of blecMling wjis found, and there was no wonnd of the intes- 
tines. The alxlominal cavity was given another flushing with tJie salt solntioD. 
and tht^ wound (tlosed with deep and superficial sutures, two ganze drainage strips 
being left in at the lowest end of the wound. Patient was pnt to bed, and bS- 
water l)ags put alN)ut him and stimulants by hypoilermic method giyen. He snf- 
fered a little from shock. The next morning he was not so well. He gtew wone 
and died at 13 o'clock noon Febnuiry 7, 11K)1. 

Necrnpsi/ (firenffj-tnu) hours after tfeath). — Bodvthat of a well-developed negro; 
nutrition good; pupils dilated: rigor mortis marked. Heart: Weight, SS7 grams: 
normal. Right lung: Weight, 055 grams: congested, otherwise normaL Left 
lung: Weight, 5'20 grams; congested, otherwise normal. Liver: Weight, 1.W0 
grams; normal. Spleen: Weight, 140 grams: normal. Right kidney: Weight, 
170 grams; normal. Left Iddney: Weight, 100 gnims: normal. Pancrew: 
Weiglit, 1 25 grams; normal. In the abdominal cavity was found some thin, dvk- 
colored fluid (nauains of normal salt solution). There had been no mon 
hemorrhage. The original hemorrhage had in all probability been a aeoondirr 
one whi(;h came from a woimde^l vessel in the stab wonna of the abdondnu 
parietes. Numerous adhesions (new) bound the intestines together. Most of 
them were alxiut sit4> of stab wound. No more pus was discovered. Intesdnes 
wen* carefully examintnl for a imncture, but none was fonnd. Omentnm wasoon- 
gestecl and sliowe<l a wound; other organs and tissues normal. Case was one 
of infection of iHjritoneum by point of knife carrying infection deep among thi 
intestines. 

J. H. O. 

Cirrhosis of lirrr, 

T. S.: male; white; ago. .^H; admitted to hospital July 26, 1900: died JnlyaO.lOOO. 

Hist<H\f/. — Patient had btH'u a hard drinker several years prior to his illneH>. 
After fivi* weeks" sickness, with rapidly increasing a*dema of the extremities, he 
entered the hos])it4il. At that time there wiis great general anasarca: the abdo- 
men was somewhat distend(;d with fluid: eyeballs protruded; con jnnctiTie week 
injected; ecrchymoses were ])resent in eyelids and neck. His pulse was wetr; 
heart sounds wi-ak: ex])irat<>ry murmur prolonged. Liver conld notbe palpated: 
percussion borders vague. In spite of vigorous stimulants and eliminative U eit- 
ment. the anasiirca incresused; (H'chymosis (quickly appeared in both ingniBil 
regions, extending rapidly along right side, and on July 30 patient died. 

Nrcropsy {cUven hours after death). — Rigor mortis slight: great OBdena of 
extremities, which ooze quantities of pure yellow fluid npon puncture with UA 



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206 MAKINE-HOSPITAL SERVICE. 

M. H.: whito: nativity, IHinoia: aj?o, 23 yoars: a<lmitt^ t« Unit^nl States 
Marino Hcwpital, Detroit, An^nst 1, IIKX); died September 3, 11K)0. 

Iltstorif. — Patient stat^'il that hv liml Ixrn sick for two weeks before his admis- 
sion to tlio liospitiil anil ^»ye a history of lieachu-he, dizziness, anorexia, and 
diarrhea. His t4>ngno was thitrkly coated, broad, and flabby: spleen enlarged 
and tt'nder; gurgling and tend(;mess in riglit iliaii region: alMlonien distended 
and tympanitic. Tlu^ diiignosis of (»nteric fever was made, and subsequently 
confirmed l)y symptoms, and the *' Widal reaction.'' 

The case progressed favorably until August 19, when symptoms of congestion 
of right lung api>eared. On August 24 copious hemorrhages from the Iwwel 
«x.*curr(Ml, the patient voiding clots for two (hiys, and l)ecoming very weak and 
emaciated. From this he failed rapidly, with i)er8istent high temi^erature until 
Septeml)er :J, when he died. 

Necropsi/ (rlevtni httnrs tiftor death). — Body of medium-sized man, much emaia- 
ated. with no sjwcial marks. Rigor mortis i)ronounced. Calvarinm remov«?d: 
dura aniemic: bniin slightly congested, but presentetl no discernible lesi«nis: 
weight, 1.520 grams. Chest and alxlomen oiH'ned. The right lung was slightly 
ailherent to i)arietes, very much congested, and contained a number of caseoos 
tuberclcjs in uijper lobe: weight, 0.*»0 grams. The left lung was jrreatly con- 
gested; weight, 720 grams. The heart contained ante-mortem clots in botli* side<t, 
otherwise appeared normal: weight, 81)0 grams. The liver was pale, but other- 
wise nornuil in api)earance: weight, I, (KM) grams. Spleen normal; weight. 34(> 
grams. Both kidneys normal: weight of right, 220 grams: left, JWO grauitf. 
Stomach greatly distended with flatus and curdled milk. Intestinee: The jeju- 
num and ileum showtMl much glandular inflammation with numerous ulcera- 
tions. The colon was constricted about 20 cm. alx>ve the sigmoid flexure, probably 
th(» result (►f an old dysentery. Tliere was a general involvement of the intestinal 
and omental glands, lUc'iny of them Ixnng in an advanced state of ulceration. 
The other organs were nonnal. 

£• K. S. 
J. G. 

F. von T.: whit^*: age. 22: nativity, Holland: admitted to tlie United States 
Marine Hospital, BaltiJnoro. Md., June 21, 10(M): died July 24, 1000. Diagnoses. 
enteric fever. 

Fa m ilij h istnri/. — Ch lod. 

Previous hintor If. — Habits goo<l; never had any venereal disease; had malarial 
fever two years ago. Present illness l>egan with a chill on June 18, previous f > 
which he had not felt well for five or six days. Following the chill he had f erer. 
but no sweat; felt quite sick up to the 20th of June, wlien he had another seTere 
chUl, after which he felt very weak and dizzy. Was admitted the folLowing day. 
June 21. On admission the imtient's general condition was good; bowels consti- 
pated; abdomen distended ^vith gas: complained of headache; temperature, 89.6 . 
The next morning the temi>erature was 8T.N , and ran an irregular course throogh- 
out the rest of the illness. Eruption absent: alxlominal tenderness not markra at 
any time during the course of illness: charact^^ristic typhoid stools. July 18 
patif^nt cf)mplaint»<l of slight imin in l)oth knee jointa, which, however, soon di*- 
apiK'are<l. July 22, at a. m. , b< )th arms were notici'd to be swollen in the region 
of the el1>ow joints and ass<K'iatcd with constant and severe pain and tendemew, 
being more pronounced in the right arm. The swelling increased very rapidly 
throughout the day and succeeding night, and on the foil owing morning it extende<l 
from tht» shoulder to the hand and was o'dematous in character. The next day. 
July 24. tht» right arm was swollen t«) alumt thre<» times its normal size; left arm 
was also greatly enhirged. At 12 o'clock of sfime day pronounced gaseous disten- 
sion of the alHlomf*n develoi)ed, followed ])y rapid and feeble heart action uul 
sluillow and hurried respinition. Patient di<*d at :{.4.") p. m., July 24, 1900. 

\rrrnjtsff (rii/hfirn honmaftmhuith). — Post-mortem lividitymiirked independ- 
ent parts: ri^j^or mortis disapiM*aring; body eiiuiciated: pupils equ^ and dilated. 
Pericardial s«i<- op<'m*d: cinitained 110 c. c. of straw-colored fluid. Lungs: Right 
weighed 5:}.") grjinis, left one 4^50 grams. Both lungs showe<l hyix)static conges- 
tion. Base of left lung adherent to chest wall posteriorly and to the diaphragm. 
Al>dom«'n distendfil with gas: stomach empty, normal in appearance; lower part 
of small intestine highly iufianietl. presenting numerous points of ulcerations. 
one of which i^Tforated all the cojits of the intestine alN)ut 15 cm. from theileo- 
ciiM-al valve. No fecal matter had escaiM-d int^) the abdominal cavitv, norwM 
theri' any evi<lence (►f hemorrhagt*. Mesenteric glands were enlarged. Venni- 
f(>rm ai)iH>ndix normal. Large intt^stine empty and in nowise invmved. Liven 
Chocolate color, somewhat engorge<l; in otheV re8]:)ect« normal; weighed 1,976 






HAMINK-IMHIMTAL ^KKVirK. 'JOT 

• 

KMmtj*- Ijpfl wp||tht«l IVi irnunn: riKht •nif iTit trn%m»: Uitli imnnAl in 
MmMmnrf*. (Nhc-r |«rtii *•( th«* tr«'iiii'» uniiary tni«*t miniial. 
i«M ffnunii. wan vrry iHtft aihI htk')il> (-••iiKi'«iti«l ( ul\Mntiiii 
tirmiB wiicbnl l.Vi%imunfi.iihi{htlyiiiui*iiiti-.iith«Twi*«*ii<iniuiI. iii«-iitii- 
BitlJi amui •waillm. tbi* nuht iiiiiri* t^* tUnii tht* b-fi. uUmt thn^t* 
NsBAlnrml alap. Tbp riKht miii. «*ii Hc<i'iiiiii. wim ••lwr\iil !•• U* th'in>iit:lily 
vtth m pak* f«<iiiltiili rtnl«l, mthcr thin in oai-iMrm y iinil ^liuliily mintftii» 
It !■ rhrarfT. All tht* tiw*it««. tht* nniAi tiUr in iMirtii nliir. wi-rt* •-•ft urifl 
\j llqn^M.cif A liichl in^viiiNh itiliir mikI put nil ■Hinr. inttiruiin;; U'lciniinik' 
Thm lf*fl Arm pr%-«*nt«<i1 tht* iginif i-liiirm ti>n«tii-«. Imt in n 1t*«ui i|ftfr««v 
til thia dwt n u'tU't* pi^MfMi. toirfilH*r with tin Miitlilftn ■»«••! uml rapiihty 
•tmiitfljr ttfiicicvatM luui.'vt k'dntcn'U^ . ilui* v» \rn<iiui ••)«*triii ttt*ii. pnih 
aMy wtf thrjubutac unjciu. 

M \V <i 

<;. IV 

/■•||f|ININ«l/l'*ll «•/ Mi/tJlfin* • • fift rifia iiflff* . 

JL St.: AIP^. 3>*i: MitiritT. Ni»vaS«iiiii inlniitTt-l in ili>- ni:iriiif Hnnl i'f th^ (f«T 

HcMfHtal. riitlwlrl|ilitJi. Pii Jiiniuiry I.' r.MM: ili*^! .Limmrv It. 1'mM 

iftaitw^ Wan tAkra «i«'k •lAniijir\ *.* with ili.irrh«'a < ^i .iiliiii«M»i*<n i-<>iiiiil:iitif<l 

' 4ii ■ ! ■■ w ■ « <»m'fml fM*linic ''f WfiikiM-^.iin<l ^onntit:;: Wu^ utuilit*- t>< ki'«-p 

■« «l«<iuM'h IktWfU ni'tvitl '.*>» !iiiii-"i •Itiniu' th* •l.i\ !!•• wii-» k'*%*ii 

^mmm»»f liiMlinth i*«itiiliirit^l with itpiuiii. iil«i fr**I\ •tiimsU^i •! *'iit Aw\ mi 

rxmlftpap c« th«* rTt^niiitc **f tht* 1 tth 

i>f«f ' f w-lnr AffHri t%ft»r il>»ifh — -|l«H|y i« ihti! • ! i« whitt- !:..ilt'. Wi-ll ilcVi-I 
«mb4 ABrl wrll nftinshi^l. Kii'itfht. I '■•• |«<iiii<l* riif'T iii-'rlto iii.irki<il Th'ir^ii 
fW^mrhmn ift««nuAl. thi ••lh*^iiin« fxniLiii . • r i-rTnoh n ]|t-.irt w-i>ii;)i« .:7ii 
gwwm^ iBMitifa mhI »lijipp ni>nii«il. ^.ihf^i i-'iii)«-t* n! ('li<ril.f iiui|iti*.i' ;iii<l 
«ar«3fArT biiim'1*^ n^iniuil ('•'rMii.ir\ .irTi ri» - t.'iuia! \ !• u- «iiuill .%*\\> r'<iii.iT.i>M« 





y*fc kp« ni»<i t!j«* »trtA \^f\ { !• Mri* ii"nii.i! !.• fr In*.,; \V*u').t. l'.>* k'r.ktii*. 
<'• • c tlATk r««Mi*h l'r*«W!i iu..»!li-l • ..ij»:-TtTi ■■. -r* I.-. ;--'a'i- i'.».jt-' ». in 

A» f »K w Srt>t |«'rti<ifia •■iiM«t:<:i ••irf iifi** .1:. ' »;!i-?i lir:..- < r< ;>.'.tii* Thr •iijli 

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i«i»^t|iin mirfin ■• lii'-l-T ;ii.«l k'li-'* IHJ.-T ' r» ;.:«.»".-.!i •l.ri.;^**i"'i* . i ■■•; 
1 firm Tb«* n••r^•' !rtink« iiml «!i.i|'lir.i^iii .ir* ri'-rii.k! \*«!'i::>;. < *!!:• r 
IBM »«ViA] S|4««-n n"nii«»l. wiU'K* l'-** .'r.iiii« (' !i«'.-*> •:> \ *.ri.. 1 >«, %. v .1. 
f«Ip ai^l fi41i«-|*^ n-^rmal Tr.*)** fi!.i- ?■ r iii>r>.i-M<l K-.!r.>\- iC'^'i.' »•'«-** 
i:** gr»ga» Irft. writfht '-•*■' irrMUi- i".i|-'i!t^ !,■■• .lii.. ■• - • • •?. - ••: ; 'a 
a>S» «mlk*« «ijtl (■•Iviii. ii<<niiAl Mipr.i r« 'i.i! ■ .i|>«':'- •< t: r* ..»! I r.r.i7\ ' 1 ! !• r 
tojtfVft*] «^ -cilAib* •(•tu*- iinn«- K'^ T11111. 'I'l-l' ii'ti:. « i:i.k< '. ?. ':i..t ft. !!•!■: t<» 
Jia'iTl l.ltrr. W«*tiSht I 'ih* tfr.ilii-. l.-rnt.ii I'.i*.- ?> »<• *. . ir ; !• !■!« .1- •> i.i'^ti 
%>r« frtfiuAl SiuaII iiift'^tiiii-^ ii>iriii.il in • .i!-.l« r .ir -1 r)t '»!.••« Mi; .-i^ !i.> m 

■ I Tlifn- arf niaiiv •in.i'.i li. lu-rri..!," .ir^-.k- •^•i*.- ••* "• *••! 
•^Aftfl I'Ul pr«tinlii*liTl\ l«ir.'i tr.lt «* lit - n ri:. 1! lirt-ki* \ • ^«> N • ri:„kl 
l»ia ABtl iiii&aI rMirl wt r«- ii<-! • &.tni:ii*oi 

W A K 
M. \V A 

IKPLAMMAIIi»N "K INT^>rlN^> 

.|^t|«:../l.|'.« 1- ■ 

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|«?aI *^A|ir^ttfi **lAtvn l^Uliil N \<!.^-; -•• ! 1» • - 

H%mf -^f Tb«- |Mli«-nl Kiafi •■? -T :.J ; I.* -: . .• .i- ! 1. .'...» i - • ■ I 

i«^ >i tljr prvwht yrar >»•• li.t*! aii .k*^l k ' • u .; • 1- > ^ i. * -.. 
• ii'^W la«^«iliitf !•■ «lk<r« I 111 t hi- r :..-!.' •..-..». r< . Ml-' 

'%(^ ti>if t.ai4 AittilMrll' mi^l:> IfK .11. Ik'i'^. ' . ' . '. I - ' 

«fc fc lw M W-fl iiil. Tb«* ai"*! .iiiil .i!>.»i k • .in.< .»' < . N 

fc 7ft h hkr tk«* Aral III*. At th.- itiii. f .t!! - '. * :» ■ .' 

WW Mlla th«* rifc'hi »'lf ' f th> .1-1 ii.- »••.'..■ « • . • . 

Isf^vla ll»l Iftvn III* tM> •III- • 1 1 • ? * ' » > !>.;•'>' 

I a^4Bf4 Waa gltrU. fti|Ifi1iir«| ihi I.' ^f •! I • • • I I ' «« ' 

t«4Bltni. An i'l- lu?J' li f r .1; ;- 1 !: ;'.- ^' .1- -l :. i' \ I 



« • 
1 k 



SOfi MABINE-HOePITAL SERVICE. 

H. U.; white; nntiHtv. Illinois: nfK. •22 vi'iits; iwlTnitt«l to United State* 
Miirinp HiwpitHl, Dt^tniit. Anfowt I , liMNi: di.il Sejitemlier 3. 1000. 

IUkUh'ii. — Paticut stati'd that hi' litul Ixfii Hii-k for two weeks before his admiB- 
Kinii to thp IidNiiital uiid fntve u hutoiy of himliiclie. ilizzineea, anorexia, and 
diiirrhoa. His toiiKne wax thickly i'<iut*sl. briMd. and flalibyi sjdeen enlareed 
and tcndt^r; KiirKbiiK aiid tendrniesH in riKht iliait region: nlHlniiifn distended 
and tympanitic. The (litimmBiM "f cntiMic Ti'Vii- tvuh niadu, and Hnbeoqnendj 
ciinfinucil by Hynipt^iuifi. and the "Wiilaln'nrtioii." 

Tlie caue proKrunHed favDr.ibly until AuKtist 1U, when iij-mptoniH (if cimgeetkn 
of rifjht Innjt niii^im'd. l)ii AnKust L'4 copionn hemorrhajiire*' fmm the bowH 
(K'cnrreil, the patie7it voidinfj riots fur two days, ainl bpooniinK very weak Kid 
emaciated. From thiw lie failed rapidly, mth ixstxiHtent high temperature ontil 
Septeudter :t, when he died. 

NixiitpKij (flnrii lioiim aflin- iliitlli). — Body of inedinm-Bizeduian, tnnrh eman- 
ated, with no npecial inarkn. RiRor luortiij pronounced. Culvarinm reino\-HI; 
dnra nnieinii'; brain ulii^htly ennffested. but pri>B(>nt«d no discernible leeiMU; 
wi-iuht. l..">2(iKrainB. Chostt and aWonien oiieneil. The right Innt; was elightlj 
adliereiit to iiarietoM. very mneh ron{;ei«teil, and contained a nnmber of easeoiu 
tnbercles in upjier lolie; weiifht. liriO Kranm. The left long was greatly «»• 
Ke<ited; weight. T2<) grainH. Tlie licart contained nnte-mortem clots in both ndet, 
othurwise appeared normal: weipht, SHd ffrniufl. The liver wan pale, bat otbec 
wiiie uomial in appearanti'; weight, 1,1HK) (oiudh. Spleen normal; weight, fttt 
gruniM. Both kidneys nomnil: weight of rif^ht. 2S0 ^raniH; left, 340 gntm. 
Stomach pireatly distended with flatnx and cn'rdted mUk. Inteetinee: Thejein- 
,nd ilenni whoweil much glandnlar intlainmation with 



tions. Thi- colon wiw constricted about 30 cm. abuve the sigmoid fleznre, probMbiT 
the result of an uM dysentery. There waH a ;;eneml involvement of the intcstliiBl 
and nmiiital glands, niauy of them Ix'ing in aii advanced state of nlcentioo. 
liie otlier urKauii were normal. 

E. K.S. 

J. a 

F. von T.: whiti': ace, -'3: nativity. Holland; mhuitted to the United Statai 
Marine HosiJtal. BaltimifPP, Md.. .Tmie -Jl, lt!0O; died July 44, 1900. ~' 
enteric fever. 

F'lniil^ liMon/.—GtoMi. 

Prt-vioui liiHlori/. — Haliits^oiHl: never luul any venereal disease; had ft 
fever two years ago. Present illness began with a chill on Jute 18, 
which ho had not felt well for five or six days. Following the chill ' 
bnt no sweat; felt quite sick np to the 20th of Jnne, when he lud " 
chill, after which lie felt very weak and dizzy. Was admitted the 
June SI. <Jn admission the patient's genenu condition 
imtiil: abdomen distended with gas: complained of *■"-• ' 
Th"- next morning the temperatni'o was 37 .8' . and ran an 
out till- rest of the illness. Kruptinn absent: abdominal 
any time duriUK the course of illness: characteristic . 
jNiticnt eoiupluined of slight jiain in Isith knee jointa, wi 
aiipeare<l. July i'i, at a. in.. lH>fb anna were noticed to 
of the ellK>w joints and assiH'iHtei] with constant and wn_ 
Iteing more pTouonuce<l in the right arm. The swelllnK 
tlininghonttliodiiyundsnccee<linK night, and on theft" — " 

from the shoulder to the hand and was (wlematons ii 

July 31, the right ann was swolh-n to nlsiut three times Its 
was also gTvatlv enhtipnl. At 13 o'clock of same day prr- - 
noil of the alxiomen doveloiieil. followeil l)y rapid and 
Hhallow and hnnie)! residriitlon. l>atient dit'd at 3.4o p. 

\iriiiii!iii(i'i!ilitii'itliiiiirHiiftrrtl''iitb).—Pimt-m<iTteia'\i'\ . 
(•nt l«irts; Hkot mortis disiip^x'arinK: iMKly emaciated; pm. _ 
PiTicanlial mh- op>'iie<l: containi'd ]li)<'. c. cif str&w-colored fl| 
weighiil KCi gTiiius. left o'lc 4:iO graniw. Both Innga showed 
tion. Ba.-*" i>f lil t hing adlnrcnt to chest wall posteriorly — ' 
Alidtnnen disti'nihsl with gas; sbimuch empty, normal in ■ 
of small inteKlini' highly in flan ie<l. prt'senting nnmerons 
one of wliich pt'rfuratisl all the cunts of the intestine ab> 
i-.ecal valvi. No le<-al matter had I'scais-d into the atv 
then- any evidence of hcmorrbagc. Mesenteric glimda 
form aptM'ndix normal. Large iut^'ntine empty and in 
Chocolnto uoloT, somewhat engorged; in other res] „ 




208 MARINK-HOSPITAL SERVICE. 

NovoiuIht 28. A small abscesR was fonnd, lightly confined by peritoneal adhe- 
sions. Tlio upii<'nflix was (.'tirled on itself like a snail shell and Ixmnd together li^ 
strong adhesions, and wtw jH^rfonited near the tip. A spot on the caecnm within 
the abscess area l(X)k(.Hl very dark and almost ready to form a slongh. The 
api)eudix was removed and the wound was drained with icKlofonii gauze. After 
operation the i>atient was nervous and restless and inclined to vomiting, but pro- 
gressed fairly well for the first three days. 

Deccnihrr 1, — The lK)wels luoved W(»ll for the first time, and with the aid of an 
enema api)eared to be thoroughly unloaded. The morning of December 3 the 
dressings w(;re changed and the strands of gauze drainage renewed. ^1 except 
one. There was only a slight purulent discharge in the dressings and the patient'8 
condition was .satisfac^tr)ry at this time. In the evening of the same day he was 
taken suddenly with jH^rsistt>nt vomiting, which soon became fecal in character, 
and the alxlomen again lHK."ame distendeil and tender. A high enema was given, 
the dr(^ssings wer(?i irhanged again and mor|)hine administere*!, and the patient 
l)ecanie easy until early the following morning, when the vomiting was renewed 
and his condition rapidly l)ecame hojwless. He died at 8.50 o'clock in the evening. 

\rrrnjtsif (eiffhtcrn hottrs after death). — B^xly well nourished and muscidar. 
Scars, apparently tlio result of a wot cupping, on the chest below the right clavi- 
cle. Rigor mortis. Slight post-mortem li\idity. Oiieration wound about 8 cm. 
long in alKlominal wall at outer border of right rectus muscle in iliac region. 
jNirtly closwl with sutures. No pus flowed from wound, but a small amount was 
in the dressings. Bones of skull very thin. Small amount of serum in the men- 
inges of the brain. Sinuses and blo<Ml vessels nwKlerately full of blood. The 
l)rain weighed 1.575 graius; externally and on scxition it presents no nnnsnal 
Ml^lH.'aninces. There was a imxlerate amount of clear serum in the pericardial sac 
The membrane was sm(X)th and 1)right. Tht^ n\}ex of the hearii extended slightly 
to the left of the nipple in the fifth inters|)ace. The left ventricle vraa contractod 
and empty, tlu) right relaxed and full of dark-liquid blfK>d. Small buff clots 
were in the aorta and pulmonary ariory and adherent to the walls of the ventri- 
cles. The aortic valve \vithst4)od the hydrostatic; test: the pulmonary artery was 
very relaxes I and the valve W(^uld not close to the test. The valve segments in 
lM)th appeared sound. Tlio mitral orifice liarely admitted the tips of two fingers. 
The tri(Mispid orifice admitted four fingers. The wall of the right ventricle was 
estimated mm. thi(?k and the left 20 mm. The heart weighed 885 gram-s. The 
left lung was nonadherent: it only collapsed slightly on opening the chest, and it 
pitted on pressure ext^inially. The. tissue crepitated and fioate<l in water, and no 
consolidiited tissue wfis fotiud: the lung weight^l 545 grams. The right lung was 
nonadherent and scanrely, collapsed at all on oiicning the chest; it pitted on pres- 
sure extenially; the tissue crepitated and fioated in water: it was filled with 
dark bhK)d, but free from any cons(jlidation: the lung weighed 075 grains. The 
alKlomen bulged and the intestines were enormously distended with gas. The 
omentum overlay the intestines and was lightly adherent to them, and a small 
amount of filirinous exudate bound the coils of intestines lightly together imiii»' 
diately ])eneath the omentum and deeper in the right lumbar and iliac regions. 
Even at the site of the operation on the api)endix the adhesions were not film. 
There was no pus in the iHjritoneal sac. and, ex(rept for the slight fibrinous adhe- 
sions at the ])laces named, the membrane was smooth and bright, though the intes- 
tinal walls were discolored and livid. There was a small amount of clear sernm 
in the dejx'udent parts of the cavity. The colon had no mesentery in the ascend- 
ing or descending? ])ortions. The last iwrtion of the ilium, to a ix)int near the 
ciecum. lijid slii)iHMl far down into the jx»lvis, turning upon itself andformiaga 
volvulus which constricted the gut Iwtween the mesentery and the brim of tbe 
pelvis at a <listance of alnrnt H cm. from the (-jecum and caused acute obstruction. 
The gut was held in this i>osition l)y the fibrinous adhesions. At the point of 
cniistrietion tlie wall of th(»gut wjw very dark colored in its entire thickness. The 
gut In-yond tliecfjustriction wjis larg(^ly collapsed: alxwe the constriction it was 
distended. The stump r>f the appendix was in process of healing, as was also the 
portion of the wound in the abdominal wall whi(rh had l)een sutured. The spleen 
was very small and wei;^he<l \)^ grams. The left kidney weighed 230 g^rams; the 
ritrht •^^{5 grams. The capsulr's stripped readily. The tissue was mottled, the 
left Ijeing darker than the right, and the natural markings were distinct. The 
liver weighed li.O'iO grams, and had nothing unusual in its apjiearance. The hlad- 
d<.T contained a vtTy small quantity of urine. 

Am \^m Urn 

a.w.a 



llAKtNK'll«»Si'ITAt. >KK\I<K. 'IW 

>KITIi'.KMI \ 

A«> ri.«ri\|t\. ?*« ••llaffl. I.t-f • lii|ti>'>i •! ••n -tiip hniui**. .iiliiiitt4'«l 

'^tjkU'm M^r-.iit M'»"l>it.il >f.ipi< foil statili l-liiin!. NnVi-iiiliiT T.!'.*"!; 
:: ' ■ r J* • '. '^ ■ • 

H.* safi'ii! |<r* -« fiTitl hitii«4 If .it tin h<i»|iiT.il M:th .i l.ir^i* ln'riiiJi ill 
- :fi «-).:•(! If- •>-i|<]>->rli •! with ilirti' nit v w ith .« trii<M IIh ici'IhtuI 

*ri { ;>h\ •)•.■! \i.;-r wip- t:*'? ^i*-). )i:it ii>Th:ii^' •!• firiiti l\ \»t<>ii»; i ••ulil 
I •;■• • \:.!« fi' f xf iii-!» r.itt- ■ linii.i'- l^r- in l»ri-t ainl •■M. dry iilinri'»y. 

• '> Arr.\i-I ?r«>iii » ti\i- in -iiTh* »jiilin;: vxya^'i* iir<<TiiMl tin- Ifiirn. ;iii«l 
I U«T; "J k .1 .rrta* i.in I'f T^jf \'t\;n:»-. l- '.i»«' • "i.tii.'*! l-* hi- )tniik hv«t 

• ia;Th .% f*